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April 19, 2013
House Committees
Meeting topics: 
CWH on Supply (Health and Wellness) - Legislative Chamber (1049)











9:21 A.M.



Ms. Becky Kent


MADAM CHAIRMAN: Order, please. I will now call the Committee of the Whole House on Supply to order.


The honourable Government House Leader.


HON. FRANK CORBETT: Madam Speaker, would you please call the Estimates of the Department of Health and Wellness.


Resolution E11 - Resolved, that a sum not exceeding $3,910,819,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health and Wellness, pursuant to the Estimate.


MADAM CHAIRMAN: I now invite the Minister of Health and Wellness to make some opening remarks and introduce his staff to the committee members, if he would.


The honourable Minister of Health and Wellness.


HON. DAVID WILSON: Thank you Madam Chairman, and good morning. It's a pleasure to be here today to discuss the 2013-14 budget for the Department of Health and Wellness. I'm joined today by Associate Deputy Minister, Frances Martin, who is celebrating a birthday today with all of us, and Chief Financial Officer, Linda Penny.


We look forward, over the next few days, to answering your questions about the Health and Wellness budget, which has seen a small increase of 1.3 per cent from $3.862 billion, last year, to $3.911 billion in 2013-2014. When you discuss those numbers with Nova Scotians, they realize how important this department is and the relevance of the numbers that we are dealing with, Madam Chairman.


As I am sure many of you are aware, health care continues to be the largest portion of the provincial budget. Indeed the Department of Health and Wellness budget accounts for 41 per cent of the total provincial spending. Last year it accounted for about 40 per cent of that spending.


In the past, Health budgets have been allowed to grow at an unsustainable rate. Indeed for a long time this province saw the Health budget increase by over six or seven per cent, in some years even 10 and 15 per cent. Yet despite those increases there was no appreciable improvement in the health or well-being of Nova Scotians. It is clear that within our health care system we must do things differently. We must discover innovative and better ways to deliver services, and we must also focus on encouraging Nova Scotians to take more responsibility for prevention of illness and protection of their health.


We are fortunate in our province to have leaders and innovators in our health care system who have been willing to take on this challenge. I'm referring, of course, to the senior officials within our district health authorities, as well as the many and varied workers within our health care system. I know these past three years have been challenging for the district health authorities and the IWK. They have stood shoulder to shoulder with the government as we curbed health care spending. Thanks to their work, as well as the co-operation of all workers within our health care system, Nova Scotia is turning the corner from a time when health care problems were deemed to be unsolvable and health care costs uncontrollable.

This year, Madam Chairman, the district health authorities and the IWK have been allocated operating budgets relatively equal to those of 2012 and 2013. I recognize that this will present challenges, and my department will work with the district health authorities and the IWK to finalize plans to manage their operations without an adverse impact on patients.


In addition, I'm pleased that our government is making good progress on halting out of control growth by reducing administrative costs, Madam Chairman, and as I attend meetings across the country with my colleagues, this is an area where they have been looking at Nova Scotia as a leader, something we should be proud of. Other jurisdictions are looking at some of the ways that we have been able to harness the health budgets here in the province of Nova Scotia over the last few years.


District health authorities and the IWK have demonstrated outstanding leadership in this area. We have already seen results from their efforts - $3.4 million in savings in 2012 and 2013, and the reduction of administrative positions, including six vice-president positions. These savings can and will be redirected to front-line patient care. District health authorities and the IWK have been working together and have been sharing vice-president positions where it's appropriate and I think that we need to recognize that they have been working extremely hard to reduce our health administrative costs.


In 2009, Madam Chairman, when we took over government, our health administrative cost was one of if not the highest in the country. I'm very proud of the hard work of the department, the district health authorities, the former Minister of Health, that we are below the national average now and I think we need to be proud of that and recognize the work that has gone into doing that.


I would be remiss, Madam Chairman, if I did not mention the senior leadership team within the Department of Health and Wellness and all departmental employees who devote a tremendous amount of effort into ensuring that Nova Scotians have access to the best health care possible here in our province and that will be our focus in years to come, being judicious about our health care spending while being innovative and always doing our best to protect patient care.

There are a number of areas that we'll be focusing on. We need to focus on children. Certain elements of this year's Health and Wellness budget revolve around a special focus on children. I believe that with early intervention our young people will have the opportunity to be happier and experience more of the fun opportunities that childhood has to offer. In addition, they will also be healthier. Because of our early intervention, as they get older, they may not need to access our health care system as often. For these reasons my department is providing $5.3 million to fund insulin pumps for youth up to the age of 19 as well as supplies for insulin pumps for people under the age of 25. Because of this investment, more than 1,000 children and young adults from across Nova Scotia will have another option to help manage their diabetes.

Madam Chairman, we are also expanding dental coverage for children by four years, by enhancing the Nova Scotia Oral Health program, one of the most accessible dental coverage programs in the country. Starting this year children aged 13 and under will be able to receive universal dental coverage for check-ups and treatment. This investment means up to 40,000 more young Nova Scotians will have help keeping their teeth healthier. Studies show that poor oral health can affect children's sleep, lead to missed school time, and make chewing difficult, which can affect nutrition. Gum disease can contribute to other serious health conditions later in life including heart disease, stroke, and diabetes.


In addition, Madam Chairman, we are investing $1.3 million to expand newborn screening to include cystic fibrosis, sickle-cell anemia, and eight other conditions, many of them that I can't pronounce, so I won't pronounce them today. We are also providing funding to develop a joint IWK-Capital Health Eating Disorder program, and continuing to invest in THRIVE!, a plan that focuses on healthy eating and physical activity to address childhood obesity and preventable chronic disease. I was very glad to attend an event, just two days ago, with one of our good corporate citizens in the province, and I think it shows that corporate citizens here in our province want to participate in ensuring that our young people stay active and prevent injuries.


Another area to focus on is seniors. This year's budget for the Department of Health and Wellness also contains a special focus on seniors. As many would know, here in Nova Scotia and across Canada, our population is aging. In fact in 2011 the baby boom generation began to turn 65. A December 2011 report from the Canadian Institute for Health Information, or CIHI as many of us know it, shows that while Canada's seniors, age 65 and older, are living longer and healthier than ever, they are frequent users of the health care system. By 2031 CIHI projects that almost 30 per cent of Nova Scotians will be over the age of 65 and with that change in demographics we encounter new health care challenges, specifically, how do we adapt our health care system in order to provide the best possible care for people as they age?


Part of this adaptation no doubt has to do with building and replacing long-term care beds. That is why in this year's budget my department will continue to fund a total of 1,800 new and replacement long-term care beds. Indeed it is important to note that Nova Scotia has one of the highest long-term care bed per capita ratio in the country and here in Nova Scotia many of our continuing care facilities are meeting or exceeding national accreditation standards. Accreditation Canada recently released a report detailing an overview of accreditation results here in Nova Scotia. In this report it was noted that the standards of compliance for long-term care services for the four independent organizations surveyed is higher than the Canadian average for long-term care, but building beds is only part of the solution and I've talked about that often over the last number of months.

As I stated above, seniors in Canada are healthier than ever and in many cases I'm sure that many people would prefer to remain in their homes as opposed to living in a long-term care facility, keeping in mind as people and persons get older it may be increasingly difficult for that person to manage on their own. Maybe they need a little help to take care of things around the house or a little support in taking care of themselves. It only makes sense therefore that we invest in providing these supports. This results in better outcomes for persons and better outcomes for the health care system overall, that is why my government is focusing on better care for seniors. We want to help seniors live well at home. Specifically this year we are investing $2 million in addition to last year's $22 million announced in last year's budget, as we continue to support programs for seniors, Madam Chairman, and that's in addition so now I think the total budget is around $197 million a year going towards support for seniors.

Programs like the personal alert service, if a senior is at risk for falls, help is never more than a touch away with a personal alert system. Funding up to $480 a year is available for low income seniors to purchase this service. Also the medication dispenser technology, seniors can receive up to $499 per year to take advantage of this service. The automated dispenser can help seniors take the right medication at the right time and will remind people if they haven't taken their pills.


Another program is the Supportive Care Program, this program supports individuals with cognitive impairments such as difficulty remembering or concentrating. People can receive $500 a month to pay for home support services like meal preparation, household chores, personal care. Eligible seniors can also be reimbursed for snow removal services up to $495 per year.

Another program, Madam Chairman, is home care. Seniors can receive nursing services at home to help with dressing changes, catheter care, intravenous therapy and palliative care. Home support services such as personal care, meal preparation and housekeeping are also available.


The caregiver benefit - this benefit helps caregivers of low-income adults who have a high level of disability or impairment. Those who qualify can receive up to $400 per month. Respite care - if respite care is needed for a loved one, this program provides caregivers with the support they need at home or in a licensed long-term care facility. Facility-based respite care is made available for a cost of $34 per day.


We also have the Health Equipment Loan Program or HELP. Specialized hospital-type beds are loaned out free of charge for seniors who need that at home. Beds are delivered and set up by the Red Cross.


Another program is the Home Oxygen Services. Eligible Nova Scotians can receive funding for the use of oxygen equipment and relative supplies. The funding may cover all of the cost or a portion, depending on the income and personal circumstances. In addition, this year, Nova Scotia partnered with other provinces across Canada to reduce the price of six generic drugs used by many Nova Scotians here in our province. This means seniors will pay less for the drugs at the counter. In 2013-14, the Department of Health and Wellness is investing $4.5 million into the Seniors Pharmacare Program to protect seniors against increases in the Pharmacare premiums and co-payments.


Better Care Sooner has been the strategy, which has over the past number of years guided much of the work of the Department of Health and Wellness. Indeed, Better Care Sooner outlines 32 areas for action that will provide and enhance access to doctors, nurses and other health care professionals. It streamlines patient-centred emergency care, taking into account the needs of seniors, people with mental illness and other complex needs, and that provide the benefit of RNs, paramedics and the 811 nurse line.


As you likely know, Better Care Sooner was born out of the research done by Dr. John Ross, a highly respected emergency room doctor with over 20 years of experience. In his report to government in 2010, Dr. Ross found that rural emergency rooms were closing due to a lack of physician coverage, and what Nova Scotians really needed was better access to family doctors, nurses, paramedics, as well as other health care providers.


Part of the solution has been the development of Collaborative Emergency Centres. Our Collaborative Emergency Centres provide access to primary health care by a team of professionals including doctors, registered nurses, and a nurse practitioner, for extended hours, seven days per week, same-day or next-day access to appointments as needed, and 24/7 access to emergency. Night time care is provided by a team that may include a registered nurse, a paramedic who operates under the oversight of a physician. Today, Collaborative Emergency Centres are open in seven communities across Nova Scotia. Specifically CECs are located in Parrsboro, the location of our first-ever CEC, Springhill, Tatamagouche, Annapolis Royal, Pugwash, Musquodoboit Harbour and Musquodoboit Valley. Same-day or next-day medical appointments are now a phone call away for families who, just a few years ago, faced long waits for primary care.


Emergency departments in smaller communities are now open more often. For example, between April 1, 2011, to March 31, 2012, the emergency department at the Lillian Fraser Memorial Hospital was closed for 2,326 hours. Since the CEC at Lillian Fraser Memorial Hospital opened in July 2012, the CEC has been closed for 21 hours. We want to see no closures, but at times there are instances where health care workers may have called in sick and it was difficult to find a replacement.


This type of change would have been unimaginable only a few years ago and it demonstrates the significant positive improvement CECs are making in smaller communities in our province. I've had opportunity many times to travel around the province to visit the CECs. I have been in Parrsboro numerous times because there is a lot of attention in Parrsboro and they are very proud of their CEC. Knowing that their community members can get in and gain access to primary care the same day or the next day is extremely important. At one time they would wait five to six weeks to get in to see a primary care clinician, now they get in that day or the next day.


As well, it's worth noting that other provinces across Canada are praising our Collaborative Emergency Centre model and looking to adopt it for themselves. As Doug Currie, Minister of Health in Prince Edward Island has stated, "Collaborative Emergency Centres are working in Nova Scotia to address emergency department closures as well as long waits for primary care. I was excited to learn about the potential that this innovative health care model holds for the province of P.E.I."


Premier Wall of Saskatchewan put it even more succinctly, "We want to learn from it and we're going to steal it." We are very proud that other jurisdictions - I have had discussions with many more Ministers of Health from across the country who have come here, who have sought the information, who are looking at this model of care.


As this year's budget will continue to support the work of Better Care Sooner, I believe it's important to highlight some of the other successes we have seen under this plan. For example, under the Extended Care Paramedic program in Capital Health, skilled paramedics assess and treat nursing home residents. These patients get treated at home so they do not have to visit the hospital. We have a two-stretcher ambulance in the province that transfers non-emergency patients from Cape Breton to Halifax.


The Rapid Assessment Unit at the Halifax Infirmary has helped divert patients from the Charles V. Keating Emergency and Trauma Centre, creating more space for those who need emergency care. Because of this unit, patients are being seen more quickly and paramedics are able to get back to the communities more quickly and I think that's extremely important. Nova Scotia has paramedics who can give lifesaving drugs to patients suffering from a heart attack, before they get to the hospital. I'm very proud to be part of a province that has embraced this. I believe it's one of the first jurisdictions in North America that has allowed paramedics to give this clot-busting, lifesaving drug in their home if they need it.


I'd like to congratulate the paramedics in Cape Breton who, a number of years ago, took part in a pilot project to test if this was something that we should be doing. We had great results and I know other jurisdictions across our country and down through North America are looking at the possibility of expanding that to their areas.


There are now more nurse practitioners in nursing homes to deliver more effective and efficient patient care to the residents. Since November 2010 patients who have had a stroke are being rerouted to new stroke units at regional hospitals to receive special care. The Department of Health and Wellness has been working to help Nova Scotians make informed decisions about their health care needs. Through the 811 nurse line approximately 400 Nova Scotians call 811 every day to receive health care services.


It is worth noting too that Dr. Ross is positive around the work done on Better Care Sooner. Last December he stated, "Better Care Sooner is resulting in accountability for improving how we deliver emergency care from politicians to health care authority leaders to health-care providers to patients themselves. We all have a responsibility to make some changes to improve our health."


Mental health and addiction has been extremely important for this government. I'm proud to say this budget contains an additional $2.5 million in funding for the Nova Scotia Mental Health and Addiction Strategy, Together We Can. As you know, Together We Can is Nova Scotia's first mental health and addiction strategy that was released in May 2012 and this strategy came about because my government heard the concerns of families and advocates who represent the people in need of better mental health care and addictions services. Indeed the Department of Health and Wellness undertook this work because Nova Scotians living with mental illness and addiction and their families deserve the support they need to live a healthier life.


Since its introduction, the Department of Health and Wellness has made good progress on the actions outlined in Together We Can. In fact, Madam Chairman, we have given $1 million in new community grants to help so that community organizations can support those living with mental illness. We expanded the Strongest Families program, which was originally only available in Halifax, to the entire province. This has taken 250-plus families and children off the wait-list across the province, most of whom live in smaller communities.


We have expanded the mental health crisis line to the entire province. We have also extended the Eskasoni crisis line. Just a note on the Eskasoni crisis line - I was just recently there on a tour and it's amazing to see the young people who are involved in that program. They are monitoring the phone lines. They have a Facebook page that people in their community can make reference to if they have an issue with addiction or mental illness. It really is a great program and I'm proud that they are able to offer it now not only to those in Eskasoni but in other First Nation communities across the province.


This budget, Madam Chairman, continues to support those living with mental health and addictions. As part of our strategy the Department of Health and Wellness is investing $1.4 million to support children and adolescents by funding mental health clinicians in our schools. The tragedy that occurred in our province a couple of weeks ago only reinforces the importance of such services for adolescents and I know that those Nova Scotians recognize that we need to continue to work in the area of mental health.


As I mentioned, my department is continuing to invest in the mental health crisis line. This service allows Nova Scotians who are experiencing traumatic events to quickly access help. I think it's worth noting that anyone can access emergency mental health services by the mental health crisis line at 1-888-429-8167. Staff will be available to offer some help on the phone. They can direct people to the emergency room, let the hospital know that they are coming. The mental health crisis line can also direct people to the emergency service they need in the community if they do not need the use of the ER.


Another targeted investment is meant to help Nova Scotians and their families trying to help individuals suffering from drug addiction. This budget invests $1 million to support Nova Scotians with addictions so that they can get help closer to home.


Madam Chairman, last year our government announced our plan for a healthier Nova Scotia and of course that strategy is called THRIVE! which addresses childhood obesity and preventable chronic disease, and focuses on healthy eating and physical activity. Our goal is to take action to reshape the places where we live, learn, work, commute and play to make it easier for children, youth, and families to be healthier. This year's budget will continue to support THRIVE!, which to date has undertaken such initiatives as providing $23,000 to six regions across the province for after school activities in rural and remote communities, where busing and transportation can be challenging; expanding the municipal physical activity program and leadership program in five Mi'kmaq communities.


Under this program these communities will be adopting physical activity as part of their daily routine, investing almost $379,000 in grants to support healthy eating in health care settings, sport and recreation facilities, post-secondary schools and provincial municipal government offices.


Knowing that breast milk provides important nutrition for babies, youth and young children and helps protect against health problems in childhood and later in life, the Department of Health and Wellness invested $250,000 for community projects that protect, promote, and support breast feeding.


Madam Chairman, these are but a few examples of the work done through THRIVE! over the past year. Under this budget my department will continue to invest in THRIVE! initiatives, recognizing that things like physical activity and healthy eating can certainly impact a person's overall well-being. In addition, I recognize that sport organizations and recreational facilities are an important part of our communities and they play an important role in keeping Nova Scotians fit and active. Last July my department announced 10 grants under the Recreational Facility Development Program. This $3.1 million investment will go towards 75 projects across the province. The grants will help to renovate facilities, development and maintain walking trails, and build and upgrade various fields and buildings used for sport and recreation.


Another area that we have been working extremely hard on, Madam Chairman, is public health. As you know, the work done in public health is an intrinsic part of what we do at the Department of Health and Wellness. Among the many initiatives undertaken by this division, this year we successfully carried out our flu immunization campaign and encouraged disease prevention and healthy development in Nova Scotia. In addition, Madam Chairman, I would like to recognize and thank our public health team for the very good work they did during the E. coli outbreak that happened in Nova Scotia last January. For a three-week period and beyond, people in public health, at the Department of Health and Wellness, and across the province worked tirelessly to understand the scope of the outbreak and ensure the health and safety of Nova Scotians.


Our physicians are one of the largest recipients of our health care funding. In 2013-14 the Department of Health and Wellness will spend $740 million to support doctors on fee-for-service and specialists working under academic funding plans. We also fund general practitioners on alternative payment plans in team clinics, Madam Chairman. Safety standards and quality patient care remain very important to me. This past year our Quality and Patient Safety branch has been instrumental in helping district health authorities with infection prevention and control. The division is also continuing its efforts to improve wait times for health care services and this year will help manage an investment targeted at reducing our orthopaedic wait times that are way too long and we need to address. In fact, new reporting requirements introduced last May will help make patient care better and safer for all Nova Scotians.


The Improving Patient Safety and Health System Accountability Act requires district health authorities and the IWK to report publicly and to the Department of Health and Wellness on the number of patient safety indicators, beginning with the hand hygiene adherence rates. Other indicators, including rates of infection, will be added in the future. It is important to note, Madam Chairman, although district health authorities and the IWK monitor and report on many patient safety indicators, they do not always report publicly or to the Department of Health and Wellness and may not be reporting the same way. This Act supports and strengthens our efforts to improve patient safety by providing greater public accountability to the patients who rely on our health care system for safe care.


IT and wait times - with this budget we also remain committed to investing in health information systems as a way to improve health patient safety and faster access to test results in doctors' offices. There is no question that information technology touches many aspects of health care in this evolving electronic era.


Our capital budget, Madam Chairman, as you know, government establishes capital budget on an annual basis to plan for projects that are more long-term in nature. As part of the jobs and building plans of 2013-14, residents of Guysborough and area will soon have better access to family doctors, nurses, and other health care providers as the province and district health authorities and IWK began planning renovations to the Guysborough Memorial Hospital. More than $1 million has been set aside to plan and design the renovations. The hospital serves communities in the Municipality of the District of Guysborough including Larry's River, Country Harbour, and of course, Guysborough.


People from Annapolis Royal to Windsor and surrounding areas will soon have better access to dialysis treatment. A new 12-chair satellite dialysis treatment facility will be built at the Valley Regional Hospital in Kentville. The province is investing more than $1 million in this year to start the construction to add the 12 new chairs.


The province is adding new e-health care technology to enhance patient safety and help reduce medical errors. Starting in Capital Health, Nova Scotia will add a secure, on-line physician system for up-to-date patient and medication information and dosage timing. A modern order-entry system will advance patient safety and is seen as the single most important technology solution for reducing medical errors, Madam Chairman. Indeed, the computerized physician order-entry system reduces the need for multiple paper copies of patient records and faxing information within the hospital system, including patients' privacy and security. We want to ensure that that is important to monitor. It also reduces medications and intravenous fluid errors, improves turnaround time for medications from hospital pharmacies, and streamlines radiology and lab workflows.


In addition, we are investing in collaborative primary care clinics at the Roseway Hospital in Shelburne, as my government is ensuring that patients in isolated areas have access to better care sooner. Last September we announced that we are fast-tracking the construction of a new health care facility for Long and Brier Islands. This facility will provide a collaborative model of care that is unique to this area. The community paramedicine initiative will have a clinic and an EHS base under one roof, to offer primary care and emergency services to the residents of that area.


This year, Madam Chairman, more work will be done on implementing the Better Care Sooner plan. The Aberdeen Hospital in New Glasgow will have a redevelopment of its emergency room, based on revisions Dr. Ross recommended to better meet the needs of seniors and all patients. As Nova Scotians we are blessed with a public health care system that performs extraordinarily well for those with life-threatening illnesses. What we must do is improve the quality of care and the time and access to care for those health care needs that are not life threatening, better care for seniors with management of chronic disease, and a shift to wellness and health promotion. These are all areas where government is working hard.

As you know, this year government has achieved its goal of getting back to balance. Getting back to balance has required sacrifice and commitment, and this is especially true for those working within the health care sector. For the past number of years we have all tried very hard to improve efficiencies and find innovative ways to deliver health care, and there is most definitely a degree to which we have succeeded.


Now, I'm not going to tell you that all these steps are solving all the problems in the health care system. We still have a long way to go, and we recognize that, and I recognize that as Minister of Health and Wellness, but there is no denying that over the past four years, government, with the support of those working in health care, have developed some real solutions that are helping real people. Just ask someone in Parrsboro, who is able to get emergency care in the middle of the night because the paramedics and the nurses are working at the CEC; or one of the dozen patients who received the clot-busting drug to stop a heart attack on the way to the hospital; or someone from the Valley, who is now able to get dialysis closer to home; these people would tell you that Better Care Sooner is working, Madam Chairman.


Health care is a complex issue that affects every single Nova Scotian in one way or another. The problems in our system have been around for decades and they're not going to disappear overnight, but we are making progress, Madam Chairman, and this year's health care budget ensures that we can continue to move forward, move forward, of course, with the support and co-operation of those within the health care sector.


I look forward to working with the people of our province to build a stronger, healthier Nova Scotia now and well into the future. I want to commend the extremely hard-working, dedicated health care providers from one end of this province to the other because they work tirelessly 24 hours a day, seven days per week, on holidays, to ensure that Nova Scotians have access to their skills. With that, I look forward to answering the questions from the members.


MADAM CHAIRMAN: The honourable member for Kings West.


MR. LEO GLAVINE: Madam Chairman, I first want to thank the minister for that overview and it points to a lot of directions of where questions can be asked over the next couple of days. I'd like to welcome Linda. Is it Linda who is having a birthday today? Okay, it's Frances, happy birthday to you and welcome here to the Chamber.


As the minister said, our health care system has many more positives than it does deficiencies and plagued with difficulties. I think each of us, as families, know the responsiveness and know the kind of care - especially acute care - that we do receive when we have to call upon the health care system. It is the major budget area of the province so drilling down on some of the budget figures is always important to do. I actually do prefer to talk about policy, about practice, and about progress and areas where we need to take the health care system, but to do some due diligence here on estimates, we'll get started.


On Page 13.4 of the Estimates and Supplementary Detail, General Administration is increasing by $160,000, and I am wondering how many more staff are going to be hired in general administration.


MR. WILSON: We have been very successful over the last number of years in reducing the numbers of FTEs within the department. We have exceeded what we've been asked to find within the department so this year we actually will see a small increase of 2.3 FTEs. That's on an overall number of about 468 individuals, so just a small increase. Some of them are due to a transfer in with taking on new programs, but we'll see an additional 2.3 FTEs in the upcoming budget.


MR. GLAVINE: I was wondering about the titles of positions found within General Administration - I guess a quick little look at that structure that would organize these 400-plus people working in General Administration.


MR. WILSON: Of course in the overall structure we have the minister and deputy minister's office and then we have a number of divisions. We would have directors of long-term care, for example - sorry, long-term care is outside - but under our umbrella within the minister and deputy minister offices we have Pharmaceutical Services, Home Care Services, Provincial Programs and Initiatives, EHS, Capital Grants. We have, of course, Administration, a certain number of people who oversee the administration of all of them. We have Public Health, Primary Care, Physical Activity and Sport, Addiction and Mental Health, and we have Continuing Care also.


We do have a good breakdown of each of those and the increase you talked about earlier, an increase of 2.3 FTEs; the main reason for an increase is some wage increases that some of the public servants have garnished through their contract.


MR. GLAVINE: I wonder how many advisors the minister would have on staff. I know he has an EA. Does the minister have a policy advisor?


MR. WILSON: I have one EA, I think the member opposite knows who she is, and we have one other part-time policy advisor. It is just the two advisors and of course we have support staff, the secretarial service that is provided for any minister in any department. We have those individuals who support me and communications and then the deputy has some secretarial support also.


MR. GLAVINE: Would the deputy have a senior advisor or not?


MR. WILSON: Not a senior advisor like an executive assistant, the associate deputy minister would support the deputy minister and she supports the minister also. He doesn't have an executive assistant, for example.


MR. GLAVINE: It's my understanding that the associate deputy minister, who we have with us here today, would have associates or special advisors who would report to the associate deputy minister.


MR. WILSON: Also, the deputy minister would have Dr. Robert Strang as an assistant, who also oversees the public health part. Our associate deputy minister just has secretarial support; there is no other executive-type assistant for individuals other than myself.


I believe we run quite a lean shop. You don't see a herd of people around me when I go to events. You don't see a lot of people around me - no offence to the people who are around me - but we are pretty lean on the support. I think a lot of people work collaboratively and if I do need additional support, it's there for me. I believe, especially with a department that spends $3.9 billion, our administration is run quite leanly, but very effectively.


MR. GLAVINE: Continuing on with Page 13.4 of the Supplementary Detail, while General Administration is increasing, the budget for the Public Health Office is decreasing. Could the minister please break down the component parts of the $1.4 million reduction in the Public Health Office?


MR. WILSON: As we go through preparing the budget, one of the things we recognize is where money is located. We realized that under that line item in previous budgets there was some programming money that was there. What we've done is shift it over to grants under Public Health so that is the main reason for the reduction. It is money that was moved out, better accounted for under another line item through grants that Public Health offers Nova Scotians.


MR. GLAVINE: Also, the budget has decreased by $1.4 million while General Administration is increasing. Is all of that part of that shift that has gone on?


MR. WILSON: I'm not too sure. I know we have had an overall reduction of all the programs listed in the estimate. I don't know if there is a specific line item, I might have missed it. We have worked hard to try to reduce administrative costs within my office to try to redirect that into Program Grants. As I said, that is why Public Health saw a reduction in the supplement information there, because we wanted that money more accountable in programming. Was there a specific line there on which you wanted more detail?


MR. GLAVINE: No, I guess more than anything, Mr. Minister, I wanted confirmation that the $1.4 million, at least on the books that we see being lost from Public Health, is in fact going into programs that will support Public Health. I know it is not a traumatic increase but there is an increase in General Administration so we certainly wouldn't want to see a loss on the Public Health side.


MR. WILSON: No, not all and I can appreciate that question. That is exactly why we want to make sure we are very transparent on what we are accounting for as administration for the department and as we get into questioning a little later under Public Health, we can talk a little bit about some of the supports and new initiatives there. We know that there will be more funding going towards smoking cessation, for example. I believe we are going to increase the support for that program by $400,000. Last year's estimate was about $600,000 so we're going to increase that by about $400,000.


As I mentioned in my opening speech, I think we do a really good job with someone who is seriously ill in the province. If you need the support in the province, you get it and I want Nova Scotians to feel very comfortable that those services are there. One of the most important things that we need to do is the prevention side of things and Public Health plays an extremely important role in that, ensuring that we have good food safety within our province, ensuring that they can react to cases like the E. coli outbreak that happened in January in an effective manner. We wanted to ensure and support those programs that prevent the use of the health care system.


I just did a recent announcement with a neurosurgeon from the IWK and it was around the use of protective helmets and I jokingly, publicly to the media, said I would love to put him out of a job and he said I would hope that you could try to do that and it was revolving around our program THRIVE! and the use of helmets. That is why we brought in the mandatory snowboard and ski helmet legislation to require helmets to be used because if we can prevent one head injury, for example - and I'm sure the member knows and through media, the initial cost to someone, and it's not all about cost, I mean the devastation, one, of the individual and their families that a serious head injury has is devastating, but the impact on the health care system is devastating too.


The initial cost for a severe head injury is around $600,000 and then millions and millions of dollars in care after that. That really is what is at the essence of the helmet law and the support we have gotten throughout the province and around different jurisdictions. We were the first jurisdiction in Canada to introduce the mandatory helmet rule for ski hills and I had media from around the world actually very interested in it and I hope it engages other jurisdictions to look at that.


Public Health is increasingly important to what we do in the department. I know a lot of other areas get more of the media attention but Public Health is extremely important to ensuring that we have a safer population and reassuring that we have fewer injuries and prevention is at the key of everything we do here in the province.


MR. GLAVINE: I'm pleased with the response of the minister, especially a couple of the references, one in particular around smoking cessation. One of the areas that I took a look at, because I've had constituents come to my office wondering about help for cessation programs and the supplementary or the complementary products that the education program will require, so I took a look around the nine districts. We have a couple of districts with nothing going on with smoking cessation. Then we have a variety in the others. I'm certainly a proponent of having a province-wide standard or program that would see that availability of programs but I do applaud that the minister recognizes the need to boost that program over the coming months.


I guess a complementary comment to that would be the work of the Heart and Stroke Foundation and some of their new initiatives, especially the ad which talks about lifestyle and healthy decisions being critical to those 10 years in the advanced part of the life cycle. I think that's a wonderful initiative. In my view, Public Health is going to be one of the saviours in dealing with the oldest average-age population in the country and targeting baby boomers is going to be very significant in trying to hold the costs to our health care system.


I'll move on to another area, on Addictions and Mental Health within the department, we've seen a reduction of $1.7 million. Does this represent a reduction of staff or is it a situation where government decided not to fill vacant positions or was last year's budget over-inflated? Could the minister deal with that $1.7 million figure?


MR. WILSON: Just quickly, to wrap up about the smoking cessation, I'm hoping the districts recognize, with additional funding coming this year, that all of them would have programs in place and I will encourage that. One thing we don't do in the department is micromanage the district health authorities. We really rely on them to bring programs forward. As you mentioned, the Heart and Stroke Foundation, we also have the Lung Association. I know the director Louis Brill introduced a run program for smokers last year. It was very successful and I know we have a lot of good groups in the province like Doctors Nova Scotia who we partner with to have a run program for kids in the schools, which is very successful.


When it comes to the reduction you see in addiction and problem gambling and drinking and mental health, almost all of that is $1.5 million transfer that was under problem gambling program costs and it was transferred from Administration to Programs. Again we have again tried to clean up the reporting in the budget, so $1.56 million is a transfer from the Administration to the Program side of addiction and problem gambling.


MR. GLAVINE: Continuing on Page 13.4, we've seen a slight reduction of $110,000 in the line item Quality, Safety and Wait Time Improvements. What is accounting for this reduction?


MR. WILSON: Again, one of the things that we had in that division is a program and administrative officer or a Web master. Part of that money has accounted for that term which will end in June of this year, so it's not a complete year of salaries. We also looked at a reduction in spending analysis, purchasing efficiencies. One of the things we've done over the last couple of years is try to improve how we purchase stuff within the department and also supporting district health authorities in more efficient ways of purchasing product that we use or any of the services.


Another area with increases we anticipate, as you could appreciate with a staff of over 450, there are times of the year when we do have our vacancies. We need to account for that for in the budget, so that would be a reduction. One of the other areas that we've been very successful in is purchasing of paper and printing, ironically, and being more efficient than we were, really trying to curb how purchasing is done, some vacancies that will be throughout the year, the ending of one of our Web master FTEs and of course some of the material that we use within the department.


MADAM CHAIRMAN: There has been a request for an introduction. I will now recognize the honourable Minister of Economic and Rural Development and Tourism.


HON. PERCY PARIS: Thank you Madam Chairman, and I would also like to thank the member for Kings West and the Minister of Health and Wellness for giving me this opportunity. I would like to bring the attention of the House to the gallery opposite because we are joined by four guests. I would first ask if Colleen and Joe could stand, and also with Colleen and Joe this morning are their two children. These are four residents in my constituency who I've met with in my office and I would ask Lucy and Owen to stand and receive the warm welcome of the House.


MADAM CHAIRMAN: We welcome all of our guests to the gallery today.

The honourable member for Kings West, also on an introduction.


MR. GLAVINE: I'm pleased to draw the attention of the House to the west gallery where Keith Irving, a former councillor in Wolfville, who is also looking at seeking the nomination in Kings South. I want the House to give a warm welcome to Keith as he observes estimates this morning.


MADAM CHAIRMAN: Again, I welcome our guests. The honourable member for Kings West.


MR. GLAVINE: Health System Workforce line item on Page 13.4 sees an increase of $101,000 could the minister please outline the reason this increase will accommodate.


MR. WILSON: I just had to clarify acronyms, we have so many little titles in Health it's unbelievable. That is a transfer in of two positions from Policy and Planning, so both of those positions would account for that increase.


MR. GLAVINE: I note with interest that the overall budget on Page 13.4 has decreased by $3.4 million, estimate over estimate, and if you look at the 2013-2014 estimate over forecast, there is a slight reduction of $16,000 and yet we see an increase of FTEs in the amount of 39.2 when you compare forecast to estimate. Could the minister please explain how we can have a reduction in the budget yet an increase of FTEs.


MR. WILSON: It could be just, very simply, good management of the budget but I will elaborate a little more on that. One of the things that often happens is transfers of positions. I just mentioned two positions that came from Policy and Planning, and those two positions came in to oversee the regulated professions, of course we've done a lot of work in that over the last couple of years. With a workforce of over 450 there are times in the year when we know people will go for some time, it could be maternity or leave of absence, so you do have to account for that empty position within the upcoming year.


The majority of the reductions we see there would be for those empty FTEs that will be part of the upcoming year. We've worked hard, as I said earlier, to reduce the number of staff within the department. I think at one point we were at over 800 FTEs within the Department of Health and Wellness and now we are down to 450 or so. We've worked extremely hard to try to amalgamate positions, try to ensure that people have skill sets that can provide more services and utilizing fewer FTEs. I think we've worked and demonstrated over the last couple of years, if you look back to past budgets, you've seen those FTE numbers drop significantly within the Department of Health and Wellness.


MR. GLAVINE: Before continuing line by line examination, I would like to take a few minutes and address few of the initiatives contained with the budget. One of them which we are all very pleased in the House to see finally realized are the insulin pumps and according to the Budget Address the department intends to spend $5.2 million for an insulin pump program. Can the minister tell us in which line item we can find funding for the insulin pump program? I'm assuming it is probably Other Insured Programs in which we saw an increase of over $8 million and I'm just wondering if that is the case.


MR. WILSON: Yes, it is under that line item. The total cost - of course, as you introduce a new program or service, you need to account for what are the possibilities. So we know if we have 100 per cent uptake that we need to ensure that we allocated the appropriate funding. The $5.3 million is the ceiling; that's what we put into the program. I know the member opposite, and all members of the House, have worked, discussed, and educated themselves over the last couple of years on the use of insulin pumps. I know the Diabetes Association has worked extremely hard to educate us all and I've said this before as a former paramedic, diabetes made a lasting impact on me. I've said this in my encounters with those diabetics in the province and realizing how important it is for someone to regulate their insulin and be able to function well at work, at school, playing, being active.


It has been a challenge over the last number of years and I want to take this opportunity to recognize the work that we've done over the last three years to get into the position where we have introduced a balanced budget this year. It gives us the opportunities to look at potential improvement of services or new services in the province. This was one that I know we wish we could have done sooner. It's one where I wish we could provide even more services for everybody but we still have to work hard in the coming years, in this upcoming year, to control health care spending and redirect any savings we have to front-line through health administration.

I'm glad to have been able to have put this in the budget this year. With support I know our caucus and all caucuses and many of the young people across the province had a great event. I know you were at the event where it was amazing to see the engagement over the last number of months and years from young people, and engagement from people who won't even benefit from this program. That's the thing that amazes me the most is that we have parents who have an insurance policy or coverage that will cover insulin pumps but got behind this initiative and really supported it. But it was really the kids and hearing them and seeing them get signatures and talk about it.


One of my own daughter's friends was recently doing a project, ironically, in Grade 9, on why insulin pumps should be covered for children. I'm glad that maybe she will have to add something to her project that we are able to offer this. I know that it has been appreciated by the public, by those individuals who have advocated so hard for this over the last number of years.


Insulin pumps aren't for everybody. There is a lot of work to them. You are attached to a piece of technology that you have to monitor and calibrate but it does help. It does help individuals control their insulin level, control diabetes so that they are not utilizing the health care system more. As I joked to the neurosurgeon a couple of days ago to try to put him out of business, I don't mind people putting me out of business as Minister of Health and Wellness - as long as I don't lose the election that's not what I mean by this - to allow me not to have to worry about providing more services because of complications from diabetes, for example. I was glad to see it in the budget and I know the member opposite was also.


MR. GLAVINE: I'm not going to digress and give a report card at this stage. The minister and I get along very well and I want to continue on that note for sure. I know as you build this program, and as the minister said, it is going to be one that will be very valuable to our children. Not every child and family will pick up on it but I think many will. I certainly saw, in my previous life as a school administrator, when we had one child with a pump and three without, one of my jobs was to make sure at noon hour that the three without a pump had their blood sugar levels checked. I think this will be a wonderful program for our province. At this stage have you at least, in a general way, identified a number of pumps that will have to be purchased as this program develops?


MR. WILSON: We believe - and of course the data changes all the time - but we believe there are approximately 1,060 Nova Scotian children and young adults, less than 25 years old, living with type 1 diabetes for example. In that number it will be hard to judge on how many will come forward or how many will benefit from it. We spend tens of millions of dollars for diabetes care in the province. We recently added to our formulary some long-lasting insulin, for example, that will require individuals not to have to inject themselves as often. There are a number of initiatives that we have done over the last little while even though we were in a time where we were trying to harness not only the Health budget but get our finances in order as a province.


As I said, just over 1,000 people with type 1 diabetes who we think are under 25, it's not an exact number, but we anticipate a good number of them will investigate the insulin pump. It is not as simple as saying I want an insulin pump, I'll call the Department of Health and Wellness and get it. They need to work with their physician, with their primary care clinician to see if this is the right one. They are going to need to work with the IWK and those in the programs that support individuals in Nova Scotia who do utilize an insulin pump. There is a lot of training; there is a lot of dedicated time not only by the individual but by parents who need to ensure the proper function of such a device and we look forward to doing that. We also know that in that 1,060 that about 640 type 1 diabetics are under 19, so about 640 kids may have the ability to gain access to this program.


MR. GLAVINE: Again, where it is a new program I know that there are probably still some aspects of that $5.2 million that will have to have a breakdown. I just want to confirm; supplies for under 19, I believe, will be covered, I just want to confirm that. But then in terms of supplies for children under 25 what part of the budget, is there a percentage in terms of breakdown within the program.


MR. WILSON: Just to be clear, it will be under 19 will receive the pump and supplies if they ask for it, under 25 will receive supplies so out of the 1,060 we believe there are about 420 type 1 diabetics who are between the age of 19 and 25 so we anticipate approximately $1.4 million of that $5.3 million to be allocated towards that part of the program.


MR. GLAVINE: The Diabetes Care Program in Nova Scotia offers a good platform for the delivery of the insulin pump program because the program works with a number of diabetes centres across the province. Will the insulin pump program be led by the Diabetes Care Program or will this government centralize the program in Halifax much like they did when they made the decision to fund Lucentis?


MR. WILSON: Hopefully the member appreciates those are some of the details we're working on right now. We're trying to move as quickly as we can so that nobody falls through the cracks over the next coming months. When we have those details we'll get them out as quickly as we can, we're looking at all options but of course we want to rely on those experts who have I think been providing tremendous service to Nova Scotians who have diabetes. We'll have those details soon but unfortunately I don't have them right now, it's not all finalized and when I do I will make sure that the public and the member opposite get all the information about who, when, and where the program will be delivered.


MR. GLAVINE: We all know that there are very young children - three, four, five years old - that we have all seen with the insulin pumps. If we look at the child within the program up to 19 years there is a chance of a need of a second and perhaps even a third pump. Are we talking about applying once or is that child now getting a guarantee that they'll be able to continue the use of the pump. We had a classic case recently of a 21-year-old whose pump was not able to be replaced now because they were outside of a program that was covered by the parents health plan when they first were able to get a pump and then when they were out on their own they weren't able to afford it and it was becoming pretty catastrophic in terms of working to re-control his diabetes. We know that once started there seems to be that need to maintain. Is it an application once and you're looked after throughout if you do require a second pump?


MR. WILSON: The purpose of the program is to ensure anybody under 19 has access to a pump is that is deemed the appropriate care that they should get to manage their disease. I foresee if a two-year-old receives a pump and four or five years down the road they need another pump that's why we have a program. We want to cover all children up to the age of 19 with a pump and I would foresee that a program, once we get the final details, would adapt to change in technology for one, but improvement in technology. You don't have to be here long to know how quickly technology changes.


The point of the program is to cover those under 19 with the pump. The specific details will come out but I would say that if for some reason the pump they currently have is not appropriate or is not functioning, they will be able to get another pump.


MR. GLAVINE: One of the other new programs announced recently, the children's dental program, is an initiative that is both beneficial in the short term and in the long term, in terms of children and eventually adult health. Without good dental and gum care there is the possibility of diseases and other costs to the health care system.


The minister references 40,000 children who could benefit from the program. Is that the number that currently doesn't have insurance, a general number that doesn't have insurance programs that they can now get the benefits from? We know there are many work programs, both private and public, that their children are covered for dental care. Is 40,000 the cohort in the gap of 10 to 13 years of age that exists?


MR. WILSON: With the dental program, we are very glad to offer this additional coverage for those children. I want to take this time to thank the dentists throughout the province who have been working under the current program, who were very supportive of our move to include more children under the children's dental program here in the Province of Nova Scotia. I had an opportunity recently to travel to Dalhousie and go through the school there as we announced this program and saw how young, new dentists who were in training were supporting and giving back to the community through supporting individuals who don't have insurance coverage, who might be over the age of gaining access to this program. They have been very supportive of this and as I said in my opening statement, good oral dental care means a good healthy person.


With the program we anticipate an additional 4,984 kids each year, about 5,000, aged 10, 11, 12 and 13, on each of those levels, would potentially gain access to this program. The total budget of that is $2.1 million. The overall budget for the whole program will be just over $6 million. The cost per participant is about $105. When a child goes into the dentist's office, the average cost is about $105.


We're looking forward to getting this program up and running. I must say it will be fully functional before the insulin pump program just because the insulin pump program is starting from scratch; there is not an existing program. This one, we just need to make some technical changes to allow the dentist to bill the province. I'm anticipating a quicker turnaround on this program. In the next month or two I'm hoping to be quicker than that so people can gain access to the program.


We anticipate about 5,000 kids in each of the additional years - 5,000 10-year-olds, 11-year-olds, 12-year-olds and 13-year-olds, those are the 40,000 kids. (Interruption)


MR. GLAVINE: I think I got that clarification there. The Budget Address on Page 6 made mention that government is allocating $4.5 million to Pharmacare to protect seniors against co-pays and premiums. Page 13.5 of the Estimates and Supplementary Detail shows a $7.4 million reduction in government funding estimate over estimate; and a $3.2 million reduction forecast over estimate. Could the minister please tell us whether these reductions in budget in the Seniors' Pharmacare Program include government's additional allocation of $4.5 million?


MR. WILSON: It does include that. I'm glad to see a reduction in that program. I need to explain that because it's the work that we've done over the last couple of years and more recently the last year on the Pan-Canadian Generic Drug Price Initiative. Across the country we have worked in every jurisdiction in the provinces and territories to work on finding six of the more highly used generic drugs across the country. We went to the drug companies and we have negotiated a cap or ceiling that we are willing to pay for these six generic drugs, which is 18 per cent above cost, and we are going to see direct savings from that.


The ones - I'm very proud of - who will really notice it is the Seniors' Pharmacare. Seniors in the Seniors' Pharmacare still have to pay a co-pay. Some of them have different payment arrangements where they might pay a certain percentage each month. Some cover that co-pay at the start of the year when they go into the pharmacy and they owe $400, maybe, for a co-pay, they pay for the price of the prescription, and when they get up to their maximum or their co-pay amount, then they don't pay another dime for the rest of the year. By us reducing the cost of drugs - like the six generic drugs that we have on the program now that are capped - when that senior goes in and gets one of these prescriptions filled, if they are at the start of their year, for example, it's going to cost them less, which I think is a good investment.


Also, I think we've seen a willingness to work together to try to get a fair price for drugs here in Nova Scotia and across the country. What amazes me, as a country like ours, we have one of the highest drug costs in the world, which concerns me and that's why we've put a lot of time and energy into trying to figure out what we can do with reducing costs. Of course, we have an agreement with pharmacies around the province now, the other generic drugs are at 35 per cent; other jurisdictions are much lower. Recently in Alberta, in their budget, they are going to 18 per cent on every generic drug. The Province of Quebec has legislation that says they are the lowest in the country no matter what. If anybody gets a better deal, they get it, so Quebec has gone now to 18 per cent.


Just going with the six generic drugs that we've listed as a group across the country, there's about $100 million savings across the country on that. We're going to see several million dollars saving in Nova Scotia. We're now looking at and putting some energy into brand drugs. I'm glad to say that Nova Scotia is co-lead on trying to move forward with that initiative. That's going to be the work we're doing over the next year when we meet as Ministers of Health across the province.


It's amazing to see the collaboration across jurisdictions. We have Ministers of Health from every single Party out there. Well, not Green Party, there is no provincial government with Green, but we have a Bloc member; we have Saskatchewan Party; we have NDP, Liberal and Progressive Conservative who are all working together, realizing that jurisdictions across the province are struggling in the matter of trying to harness the health care budgets. I think all or well over 40 per cent of their provincial budgets are health care. Here in Nova Scotia we're at 41 per cent now and really trying to ensure that that doesn't grow to a point where it's not sustainable.


I think the work on generics is extremely important. The work we're going to do in the upcoming year on brand names is important, but we also want to work with our pharmacies and pharmacists around the province. The member opposite and myself attended a reception the other night with PANS, the Pharmacy Association of Nova Scotia, and I recognize how important a lot of these rural pharmacies are to delivering health care.


I've said this often that I want to utilize every single trained health care provider in this province to the best of my ability and to the scope of practice that they are trained to. I think an area that has been ignored for a long time is the opportunity to utilize pharmacists in health care delivery. These are people who meet people every day. They have really good working relationships and communications with individuals. They are in their stores not only buying their prescriptions but buying product, many of our pharmacies offer many services.


They can play a part in this and I think they had a good presentation to us the other night on the potential. I want to explore those potentials and I think they recognize that their business model as a pharmacy can't solely depend on the profits they're making off of pharmaceutical products. I know they want to work with me. We have an open line of dialogue. I've met with them recently, with the President, Andrew Buffett, and Rose who used to be - I know the minister knows Rose. She is still active even though she is not president of the association. I think there is potential there to work with them, to ensure not only do they have a good service that they are providing, especially in rural communities, but what lies in the future.


I'm very glad that we are working with them, currently, to try to get them on board to participate in the next flu vaccine campaign. I know that we've been negotiating for some time, trying to figure out how they recoup the cost because they are business owners and we realize that if they start providing a service, there needs to be some compensation. I am glad and hoping really soon to be able to make an announcement on that. I am confident to say that they will be participating in the upcoming flu vaccine initiative that we'll have in the Fall and I look forward to working with them as we try to explore what other relationships and services we can partner through them, to provide service to Nova Scotians.


MR. GLAVINE: I know the minister has the opportunity to meet with his counterparts across the country and gather information on kinds of impacts. One of the impacts that I hear on the small rural pharmacy is a lot of movement on the generics in a very short period of time and compensating on the business impact has certainly been there. One of the other concerns is around shortages, that companies may no longer be in the economic position to provide a particular pharmaceutical product, a required drug. I am wondering if there is some registering and monitoring of potential. I know we have a few drug shortages with the orders from pharmacies.


MR. WILSON: Thank you for that question because it is important. One of the concerns from the generic drug companies and pharmaceutical companies, as we move forward - and the member is right on moving forward, I think in a quick fashion around the changes in how we cover generic drugs in the province. The Ministers of Health have been talking for years to try to move forward on different initiatives. The Premiers of the provinces and territories meet on a regular basis and a little over two years ago, I think, recognized the importance of working collaboratively across Canada on the pharmaceutical side of things, but more importantly on health care.


They created the Health Care Innovation Working Group, which was co-led by Premier Ghiz from P.E.I. and Premier Wall from Saskatchewan. Not only have we met as Ministers of Health with our federal counterparts and individuals but we've met with the Health Care Innovation Committee on a number of occasions. We just met with them in January in Toronto and what happened over the last year and a half was a report that was tabled to the Council of the Federation or the Premiers table, recently, as our Premier hosted and chaired that committee.


That report showed some of the best practices, some of the initiatives across the country that jurisdictions are doing really well and the Premiers have kind of ordered us as ministers to look at the list and implement it. They have given us strict timelines. At first we thought maybe we won't be able to meet those but we realized the importance of having timelines when you have a report like that because we are all extremely busy. The Department of Health in every jurisdiction across the country is, I think, the most important department in government. Maybe the ministers on either side of me might not think that, but deep down I know they know how important the Department of Health and Wellness is in providing services to our residents.


There were strict timelines on a lot of the initiatives. One of the ones that was really relevant was the fact around pharmaceutical costs. They put strict guidelines in for implementation, first recognizing what the top 10 generic drugs that are being used in the country and then pick from there. I think initially we were supposed to pick five; the jurisdictions all agreed that we would pick six. Some of those drugs are to treat high cholesterol, high blood pressure and other cardiovascular conditions, treat depression and mental health conditions, treat a number of GI conditions, and angina.


They wanted to put strict guidelines on it so as of April 1st this year they needed to be implemented, so we did that. I think the most important thing is that we are working together; we are trying to give the business owners, the pharmacies in all our jurisdictions, the time to adjust. I know the impact that it does have on them but I think it is an important transformation. It is important for us to recognize the impact of how pharmaceutical costs have driven the increase in health budgets over the last decade. I know the former minister had to deal with this and the ministers before that had to deal with it.


It was something that really was out of our control. Companies would come in, especially in small jurisdictions like Nova Scotia that don't have the purchasing power of Ontario, Alberta or British Columbia because of the population we have. It's that Walmart syndrome - the more product they sell and buy, the cheaper price you get. We have been challenged over decades to try and grapple with how to control pharmaceutical costs in the province and I think we've come up with a solution.


The ironic thing is we have a federal government that oversees a lot of the patent rights and restrictions on generics and on brands and ensuring there is free trade and no infringements on trade policies and agreements. In each jurisdiction we weren't allowed discussing what we would pay for drugs to another jurisdiction. It's in part of the agreements that we have with the pharmaceutical companies. One way around that was designating certain leads or co-leads to go after and negotiate a price and then everybody would agree we would have a cap price.


I know you asked about drug shortages so I'll get to that. One of the concerns we did hear, over the last little while from the industry, was they knew we were going in this direction, and I think they accept that now. They had a number of concerns and one was the possibility of what this looked like on how we would approach this across the country. Their number one concern was single-sourcing of certain drugs, saying that there was only one company that we would do business with and if a multiple number of companies provide generic drugs then the rest of them just lose out.


That is where they had concerns for potential drug shortages. We've seen in the past where one of the manufacturing buildings caught fire, for example, and if you had one manufacturing plant providing this certain drug and it catches fire, and no other drug company is producing that medication, then you have shortages.


That's why we took the approach where we wouldn't single-source these generic drugs. We are open for any company to provide them to us, but we did cap it, and I think that was the best move forward. It shows that we're listening to the concerns of generic companies, but more importantly, trying to ensure that we get the fairest price for drugs in our jurisdictions, no matter where you are across the country.


We want to work with them; we want to make sure that we don't have a negative impact. We all know we want to have businesses run in our provinces, so I think we've taken the steps to try to ensure that and that's how we'll work as we move forward with other initiatives.


MR. CHAIRMAN: Thank you, minister. The time for the Liberal caucus has expired.


The honorable member for Hants West.


MR. CHUCK PORTER: Thank you, Mr. Chairman, I'm sure we'll have some fun in the next four, five, six hours as we make our way through. (Interruption) I thought you would appreciate that. Minister, were you finished in that answer? I just wanted to give you a little more time, I didn't know if the chairman was looking at the clock and cutting you off there a little quicker than - there are certainly questions that we had as well on that, so thank you.


With that, staying on that same vein, I will jump into the provincial Pharmacare plan, a good plan, as we all know. I'm surprised at how many people still don't know how to get on this program, or don't know that maybe it exists for them and they qualify for it or could qualify for it. This is not unusual, at least once a month, sometimes once a week, we've got people coming in wondering about the costs of the drugs, can't afford it the way things are, losing jobs, and so on. We have spent quite a bit of time over the last few years, actually, on the provincial Pharmacare plan, assisting people and getting them set up and going through the process and so on. Can you tell me how many people are actually on the provincial Pharmacare plan today?


MR. WILSON: Thank you, this is our first opportunity to do estimates, and I know you'll be gentle with me over the next four, five, or six hours. The Seniors' Pharmacare Program is an important program, and as the member stated through you, Mr. Chairman, as MLAs, I think we all deal with individuals coming into our offices and asking, should I get into the Seniors' Pharmacare Program? I've had discussions with so many individuals who are at 64 years old and are trying to make that decision if they should go into the Seniors' Pharmacare Program, because there is a cost. It's not free for everybody.


As a program with a price tag of $172 million, I think people would appreciate that we need to try to offset that cost to some degree, so we have co-pay and we have premiums. Of course, some of them are waived, depending on your level of income. I'm glad to see that this year we have put more money into the program so that we don't see an increase of co-pays or premiums for any seniors in the Seniors' Pharmacare Program this year and that is important because we know how important every single dollar is for a senior.


Trying to address the fact that seniors may question going into it, I'm very up front with them. I say, yes, you need to get into it. A lot of them state the fact that they are 64 years old, they might be 63, that they are very healthy, they're not on any medications, why should I pay up to $800 over the year - if that's what you're at, or the $400 - when I might not utilize it? I use the analogy that we all have a vehicle, or if you do have a vehicle, you have insurance. You have PLPD or you have collision. And you can't say, well, I'm not going to get insurance today, because I'm a good driver, then go out and get in a car accident, and then call the insurance company and say, can I have insurance today because I just got in a car accident and I need you to fix my car.


It's similar. This is an insurance policy, and as you get older, you get more dependent on pharmaceuticals, unfortunately, and you do get ailments. You never know what's going to happen in the future. So I encourage all seniors who are at that point when they need to make the decision to get into the Seniors' Pharmacare Program, because there are penalties, unfortunately. We would love not to have them there but we can't have a system, and have a system that's sustainable, if people only join when they start getting ill and put a demand on the system.


It is unfortunate that's the way it is but we do encourage them, and I encourage them, and I hope all members encourage them that it is an important thing. It's like having life insurance, house insurance, fire insurance or theft on your car. We have over 4 million transactions a year through Seniors' Pharmacare for our seniors. We're trying to get the exact number of seniors in the program. We'll get that soon; we don't have that right here in the estimates. I encourage all seniors to seriously look at ensuring that they have that type of coverage.


We have other programs for those under 65, the Family Pharmacare program that not only can support an individual who might not have a third-party insurance coverage, but even if they have it, if they find themselves with expensive drugs, they can still gain access to the Family Pharmacare.


It's an extremely important program. I seriously encourage all seniors to register when they turn 65 so they can keep their costs down without getting that additional cost if you wait a couple of years and join. We have over 105,916 seniors who utilize the Seniors' Pharmacare Program today.


MR. PORTER: Thank you, minister, for the answer. I knew we had a lot of seniors and it would probably be safe to say most are likely on the Seniors' Pharmacare plan. We do a fair bit of that kind of assessment and reassessment when the time comes, usually when they are filing for their Old Age Security and getting onto that last six months as they head toward the 65 mark. They are asking those questions and there are a variety of scenarios, as we both know, with respect to income and if they are on the Guaranteed Income Supplement, things are all different with regard to that co-pay.


I was more curious about the Family Pharmacare side of it. I should have been clearer when I made my opening statement that there are a lot of families that still don't know. We try; we put it in newsletters and we do a variety of things to educate people out there but I know you can't hit everybody. We've had a lot of people come through that we've directed there and helped them get on there who just don't have benefits. What is the annual uptake on the provincial Pharmacare plan?


That is a huge piece of what you're doing, budget-wise, and there's a large figure around that. The seniors' one, I don't want to say is obvious, but it's fairly obvious to most that they would be on that plan. We do encourage them to get on it as much as we're encouraging, and more with the Pharmacare plan. One of the questions I always ask when people come in and they're in a bit of a difficult situation, we always ask, are you aware? If they are looking at drugs - are you on the provincial Pharmacare plan? Sometimes people do just all of a sudden get sick and find themselves in a position where they are buying expensive drugs and have no idea and sometimes this goes on for months that they have no idea.


I'm not sure if there is a responsibility, maybe that's not the right word. You mentioned in your closing comments as the Liberals were finishing, that you want to do everything in your power to have folks like pharmacists working to help you, I think is the right direction and the words. It would make life better as we move forward here.


Forgive my ignorance; are pharmacists or folks working in the pharmacies passing on information on the provincial Pharmacare plan when they hand out a prescription? I'm not sure they are. I've never received it in my pharmacy, that doesn't mean that they're not doing it. I have a plan. I'm fortunate but I know there are a lot that don't. I'm curious, in those situations are we working with pharmacists in this province to say, when you're handing out to someone who's paying full price, here's a brochure - do you know? Maybe you can speak to that.


MR. WILSON: The Family Pharmacare Program is just as important as the Seniors' Pharmacare Program because even if you do have coverage, we all know the new drugs that come out that might not be covered under a formulary are very expensive. Pharmaceutical companies recoup the money that they have spent on research and development of a drug through the cost of the drugs.


We know it is important. Interesting you say that. I know you haven't - I don't think - but other MLAs have criticized the government on some of our campaign awareness, not so much in Health and Wellness, I know in other areas, but I think I've heard a little bit about some of our campaigns. It was in the Doctor Ross report that he identified that we needed to change models of care in mental health, in Collaborative Emergency Centres and any of the 30-some recommendations or areas that we needed to work on.

One of the recommendations in there was to make sure that people know about the programs, make sure that people know about changes to programs, and make sure people know about new programs. We try and we try to do it as - I won't say as cheaply - as cost effectively as possible, with material going out into the public through television ads, in brochures. What I'll commit to the member opposite, we do have brochures that are available in pharmacies and doctor offices, I'll ensure that - because often there is a wall of pamphlets and sometimes if they're empty they might not see it - if they need them I'll send out a kind of information thing to the Pharmacy Association of Nova Scotia that if they need more material to let us know and we'll provide it.


I know myself and many of our members do public service announcements, or PSAs, in papers about new programs. I believe that we will continue to do that and that is an opportunity for all members to do that and between you and me, it doesn't come out of your advertising budget. It comes out of the overall budget because we are limited on what we can advertise as MLAs. I think the reason why PSAs are not under that is because there are important programs that you want to help your constituents with.


If you can support someone in your riding with a provincial program, I know you want to do that. We all have opportunities. I think we all have a role to ensure that people know about the programs. I'll venture to check and see and maybe get some of that material to your office. I know I get a lot in my office. We usually have a wall where we have different programs, even if they're not provincial programs, they might be initiatives from organizations and groups.


We have 26,310 families currently that have access to the Family Pharmacare Program and with that over 45,000 individuals. We have a budget increase of $1.5 million this year into the program, part of that is to ensure that people know about the program and they can access it and I think it's important that we all pay a role in it. I'll endeavour to make sure MLAs have some of the more current information on the programs out there, trying to cut down on paperwork. I know one of the other questions - some of our savings is paperwork. On our Web site we have a lot of information. You can go, print off one copy or not even print anything off; they can send it in through there.


On our Web site we have a lot of information on every single one of our programs, the applications for those programs. I know that this program benefits a lot of people and it helps them when they find themselves either between jobs and lost coverage, or find themselves battling a serious injury or sickness, which requires an increase in using prescriptions. We had an increase last year of 5,000 individuals for the program itself. We are seeing people are utilizing it, that's why we put the additional investment in.


MR. PORTER: I guess I'll just clarify a couple of things in your comments. Yes, some may be critical with regard to some of the things being done but I guess knowing me like you do, I'm a bit passionate about the health care side of things. The more that we can educate - and I'm not saying go out and spend millions of dollars on TV advertisement, I don't believe that's always the way either. I'm looking at the efficiencies and best "how-to" here and the pharmacy was one thought that I had.


As far as sending me stuff, you don't need to do that. I would like to think that all members in this House have a good grasp of what's going on by way of all programs but especially the health care side of these programs. We do go on-line. We can easily find what we need. We have great contacts with the department. I've got a great CA who knows what to do and we keep ourselves informed because we deal with it a lot. It's one of those things that you're very familiar with as a member and I'd like to think that all members probably are.


The pharmacies was just one example, maybe there are some areas. You think about commercials and TV; I know when they do that they try to be strategic on TV shows and times of day and the news to get the messaging out. I'm not sure how well that works. Somebody in advertising would probably give you some statistics that they believe works well for the purpose of selling but there is nothing better than getting it hands-on.


In my constituency I have 7,800 households. A couple of times a year I send a newsletter out. In that newsletter we feature programs and this is one of them. We do that for a reason, to try to continually reach out, whether it's grants for their home or it's health care issues or whatever it might be, and we tend to do that more toward the Fall as we know that is the time when the flu season and all those things are coming on and people are probably, not necessarily, but maybe more apt to be at their doctor and picking up a prescription for one thing or another.


There are a lot of people on that program, over 45,000. I knew the number was probably growing and you'll find in my questioning, I'm not reading line items. The numbers are what they are. We have no ability, standing here in the Opposition, to try to make changes. We can recommend certain things. Most people, I would tell you, probably don't care about what the line number is because it is very vague anyway. It is broad and there are so many things captured in a program. The insulin pump fit into something else; it's not even a line item itself. Don't worry about that; I'm not going to be asking you dollars and cents and line item figures. It's just not what I think is the best use of our time.


I do want to get into a couple of other things here and it's funny how quickly time passes by when we get into a conversation here back and forth. I want to go to dialysis, something that we have spoken about before, something I certainly have a position on. In my community, as you may be aware, it's a little bit different than some of the other communities and we're always asking for things. You know what that's like as well. Wouldn't it be nice if we would just have the money to do everything we would like to do? We know that is not a reality. The people out there know it's not a reality.


We have had over the years a significant number of people who transfer themselves back and forth to dialysis. I know that you and I both know well what it's like to be moving people via ambulance, travelling three times a week to receive dialysis. There is a lot of cost associated with that, whether we're going by ambulance or they're taking themselves and I know that you know that as well so I don't need to get into that too deeply, given your background.


In Windsor, in West Hants, we have had a lot of people come together over the last couple of years to do fundraising. We've had funds committed at well over $120,000-odd and probably more now. They are anxiously awaiting an opportunity for dialysis in the Hants Community Hospital. We feel that there is a place that it can be housed there. We have had people come to us who work in the industry, nurses who are trained, who said we'd go to Windsor, we'd love to do that, we'd love to come home, we'd love to not have to travel to Kentville, to Halifax, or wherever they might currently work.


I know it's easy to say all of that. I also know it's not necessarily the capital purchase to begin with; it's the ongoing and the costs that are associated with that. There has been a commitment from the foundation, as you are probably aware, from the group that is coming together to raise awareness and to raise funds.


Needless to say, as good as the announcement was for further down the Valley that you made back some time ago, in an effort to strengthen care for dialysis and put more machines in Kentville - and we will never stand here once and say that we don't believe Kentville should have machines. What I did look at though, and what was analyzed to some degree, is why wouldn't we have put it in Berwick, some in Kentville, shared the wealth in Windsor and you would have very few people travelling?


Maybe only you as minister know the answer to that, by way of what the cost breakdowns are associated with that but we really felt that would have been an opportunity to expand the program and at no less cost, especially with what we had to offer out there by way of helping provide and service this. We know the detriment that has been caused to individuals and families who have been on dialysis a long time, some travelling for more than 15 years, some have maxed out credit cards and remortgaged their homes. You know the impacts; I don't need to explain all that to you. I'm interested in your position on where we're at and where we are going with dialysis in the Province of Nova Scotia.


MR. WILSON: Thank you for that question. I know you've been very passionate around dialysis and trying to ensure that the people you represent gain access to the care they need in a timely manner and close to home. That's what we want to do as a government, is ensure that we have services as close as possible to where people are living. Over the years it is getting more challenging, especially where we see the out-migration of the population from rural communities into more populated areas. Halifax is exploding. There are new condos going up every other day around the city. That's great for Halifax. They're building; there are cranes everywhere, but it comes at the expense of rural communities.


When you are dealing with health care services, the challenge is ensuring you can continue to provide services for everybody because we believe in fair and equal access to health care for our residents here in the province. That has been an area where we've been challenged for a number of years here in the province and across the country. That is why, with Collaborative Emergency Centres, for example, it's a different model. It's a different way of doing things but it is my belief it's providing ample care and a positive change to how people gain access to primary care, especially in rural communities.


We're seeing interest from other jurisdictions that have very challenging geographic areas to cover. Out West, in Saskatchewan and the Prairies, there are some remote communities. We think we have rural communities; when you see the challenges they have - there are not even roads that go into a community, the challenges of providing health care service there.


We understand that and we're really trying to ensure we can provide care for everybody in all the communities across the province. We have been challenged over the last number of years with the finances. It hasn't been easy trying to harness and get back to balance. We've been limited with new projects that the Department of Health and Wellness can initiate. That's why I was glad to announce this year the insulin pumps that you mentioned. We are now in a position where we're starting to control government spending and reinvesting into communities as we reduce health care administration costs.


When it comes to dialysis, I know, and I've talked about this in the media, and I've talked with you - through you Mr. Chairman, sorry - to the member. (Interruption) I don't think he'll kick me out of order or anything but I know we're supposed to be following procedures - I've talked about this and I know the commitment from the foundation in your area to provide the equipment.


As we look at how we move forward with dialysis, of course we've moved on a number of different areas over the last couple of years being in this position for almost a year now. I know the former minister knew it was important to try to move forward with some dialysis so last year we invested and tried to bring more awareness around home dialysis, especially for those in more remote communities, there is an option for them to stay at home. I know it's different than the dialysis you get in one of the clinics. It does take longer and you're hooked up to a machine longer, but it allows you to stay at home. People have been reluctant because they don't know a lot about home dialysis but there are a lot of benefits with that type of program and that type of treatment.


When it comes to our satellite dialysis units, we knew we had a bit of money to invest. What we wanted to do is reduce the transportation burden on people. When we looked in the Valley, we knew we wanted to invest in that area, we tried to simply say, where in this region, if we placed or invested more into dialysis, could we address those distances that people are driving to seek that service? I think in Kentville we achieved that and we're hoping people will have less distance to travel to get dialysis.


Unfortunately, in the current environment, we can't have them everywhere so we need to be strategic with that. This year we have an additional $2 million in the budget to support that move and it's great. I think it was on CBC I thanked the foundation for saying yes, we want to participate; we'll purchase the equipment. But that alone doesn't cover the cost. It doesn't cover the personnel. The district needs to provide and pay for the training of anybody who might go there. I know you said you talked to some clinicians who would move back if it was in your community but there is an additional cost to that and we weigh all that and because of the environment that we are in, we know we made the right decision to put it in Kentville, more centrally located, to reduce the travel cost for people who have to drive themselves for this treatment.


I know it's not the answer you want. I commend the foundations across this province because they raise tens of millions of dollars throughout communities for initiatives that, unfortunately, the province, the government, former governments, and former, former governments could not provide every single service. The use of the foundation and the support we get from them and district health authorities, and that the hospitals get from them is important.


One of the things we need to ensure is that they work very closely with the hospitals that they are associated with and they work closely with the health authorities that they belong under, so that when they do come to government with future projects that it aligns with priorities of the district, it aligns with priorities of the hospital, so that we know we get a clear message from the hospital, from that district that this is a project we need you to support, because we are limited.


I think the recent Auditor General's Report mentioned the need for capital investment of over - well it's going to push a billion dollars soon but $600 million to $700 million. We don't have that this year in our capital budget, unfortunately, I wish we did. We could do a lot with that. What we need to do is set up a new committee under the advice of the Auditor General to review those capital projects. We put our capital project list out very early in the year so that we show Nova Scotians where we're investing in capital plans and I think we move forward and look at what the priorities of a district are because that's the good thing about the system we have.


I know we've had discussions. There have been debates on the number of health authorities in this province and it is our view as a government that it is important that we have community input when it comes to health care decisions. Each community is different. It's not as easy as saying, well let's just do this in every community across the province and we see that in the implementation of Collaborative Emergency Centres, for example. They are not the same in every community. We're going to have a Collaborative Emergency Centre open up soon in New Waterford and it's going to be the first jurisdiction in North America that will have a mobile CEC.


The community recognized that there were some issues around the lack of transportation to the hospital. There were people who thought, well is there a different way of doing things? I know the Deputy Premier and other care providers, leaders, were over looking at a model in London, for example, and I think the member opposite knows how they have physicians and nurses who actually go out and are in a mobile unit. That's part of how we are going to address some of the issues in New Waterford.


As we move forward we need to make sure that our priories line up in the districts and in the hospitals, and the foundations, so that we can maximize. If we only have so much money, as a department, to support projects going forward, we want to make sure that the best projects reach and address the needs of as many people as possible. That's why we made the decision to put the new dialysis satellite unit in Kentville and I applaud the foundation for their commitment. I know they are going to continue to commit to support different equipment and services in your area.


MR. PORTER: Thank you, Minister, for the answer. You are right, on some of that there is home dialysis. There's a variety of options. I know a number of people who have looked at it felt that they just could not do that. It's certainly not what they want to do. It ties them down, there's no question; it's not a three-day event anymore, now it is every day. I think there are people who are hesitant at home, even if they took the training, there are people who are just not comfortable with some of the needs that go along with looking after and maintaining dialysis at home.


I can assure you, we are very happy with our foundation. They do a lot of great work, as do many foundations around the province and country. They are going to continue and this will continue. This is by no means over, I'm sure you know that as well. There will be a point when this battle, as we call it, is won. We're quite confident of that, actually. I know as minister in a department you have much to manage over there at the same time. I think that everybody appreciates that too, without any doubt.


I want to move on to long-term care, something that I, too, am very passionate about. I've had my share of opinions about that. As I've stood in my place on both sides of this House, I've had my opinions on long-term care. You may have heard me reference it in the past as being a total disaster, the way that things work these days. That may be unfair in the mind of some, but if you're dealing with it like we're dealing with it, it's often hard to come up with words sometimes that really dictate what it might be.


There are many people in my area, and I'm sure in every area around the province, waiting for long-term care. I know you are familiar with the Hants Community Hospital. You are probably familiar with Unit 500, which has become a sort of waiting area for people who are waiting for long-term care. There are a lot of people at home who are still waiting for long-term care and there are people who are in long term care who are waiting to get closer to home.


We all know of a variety of different strategies that have been talked about - about keeping their families and their parents and seniors in homes as long as possible. I think that if you asked any senior out there, they would say, we want to stay home. I have had family who have said, we want to stay home forever if we could. They wish to stay there until they're no longer here. But sometimes that's just not possible because they require a certain amount of care, and sometimes it's a little heavier. When you're dealing with certain things, it's not just the physical aspect, there are medications that need to be looked after by qualified clinicians in nursing homes and long-term care facilities. They come to understand that and they find themselves there at some point. But the wait has been long.


We are very fortunate to have three of what I consider to be the best facilities you would find anywhere in the province. They are second to none, as are the people who work in them: Dykeland Lodge, as we're all familiar with; Haliburton Place, which is part of the Hants Community Hospital located there; and of course, the new Windsor Elms Village, which I was pleased to be part of the announcement when we were in government to see that that place was built, that facility.


It has since been opened and I'm sure that all members are pleased to see as many of these facilities opening up as we can possibly get opening, to meet the need. Now, at the same time, I've heard the minister stand, and members of government stand, and probably others, and talk about all the great programs that are in place to keep seniors at home, and I think that's great. I think seniors would tell you that whatever you can do to assist us in staying home is great. Could there always be more? Yes, there will always be more. Wouldn't matter what programs are out there and how much money you put into it, there could always be more.


Again, one of the reasons I don't look at budget and line items, the figure is what it is, and it is what you have to work with. I appreciate that very much, and I think the people appreciate that. Sometimes people get upset and we hear the banter back and forth, discussions about how bad things might be, and then we run into somebody who might be a little worse off.


What government has done for many years, and continues to do, is provide help where they can and to a certain limit. But the long-term care wait times, there have been a couple of things with this issue. In the last six months and more so and even more recently than that, we used to be able to pick up the phone, and whenever we called they'd say, oh yes, just call this number and you'll talk to so and so, and they'll tell you. One of the calls that we get on a regular basis is, how long does mom or dad have left to wait before they get in? Well, we could call up and we would kind of get an update. And I'll tell you something that has been terribly disappointing - we've been shut down. No longer can we get the update. We've been told, no, we are not going to tell you how much longer it's going to be. Now, maybe they don't know. I would rather they said they don't know than say no, we're not going to tell you.


I don't fault the folks working there; they are great people. They work hard in there but it's one of these points that it's so centralized now, everyone is just a number and the answers aren't flowing. We need to be able to update those families and family members who are waiting and people who are waiting for six months, for a year. One of the things that we do discuss very clearly with them - and you have to be honest with people and you have to tell them - generally speaking, there is only one way a nursing home bed turns over, not many people move out and go somewhere else. We know it is when they pass away that the beds open up and when is anybody's guess.


We know this week, at any given facility, you might have one, you might have none; you might have ten. It's hard to say. People understand that, they appreciate that; they know that is how it works. When they see beds opening up, they are calling. They're saying I know a bed just opened up. Where am I on the list?


The unfortunate part is we're not able to tell them. I think it's important that we're able to share some information with the families and they'll say, okay, Chuck, you can't call but get the family to call. Great. We'll give them the number. The family member will call and they get told nothing too. There is no satisfaction in that. I realize the position you're in, beds are limited. Nobody's taking that away but I think the importance of being able to give some information out, to the best of our ability, is vital when it comes to the Better Care Sooner model you so strongly try to create and you want to tell people and you want them to believe and be sincere in this. I think they want to be.


I think there is nothing wrong with telling somebody. If they know that they are 10th on the list, that gives them hope for some reason, no matter where they are at, they've been told something and they like to have information shared with them. After all, they are the working taxpayers over the course of their life who have built these facilities, who continue, through their investment of taxpaying dollars, regardless of where they come from, who are supporting these facilities and who are encouraged they are there and they want to be part of it at some point and know that they're there for them.


Some of them make it, some of them don't. Some of them don't live long enough to see the long-term bed come to fruition. Some of them die in the waiting areas like Unit 500 or at home with family members. We can't control that either. We realize that's going to happen; there are some things we have no control over.


I want to come back to that first piece about it and I have a fair bit on it but the first piece on it is the centralized system hasn't worked to the degree that I think that we all thought it might. It sounds easy, one-stop shopping should make it - boom, boom, we've got beds. We know the 100 kilometre piece; we know all the pieces around that. It's the lack of information that we're able to obtain and share with families that is troublesome right now. I'd like your thoughts on that, minister, if you would please.


MR. WILSON: Long-term care is something I have talked about for 10 years in this Chamber and it's an area that we need to ensure we pay a lot of attention to. It accounts for the third-largest component of our budget. Over 14 per cent of our budget, of a $3.9 billion budget, goes towards long-term care for those Nova Scotians who receive that care today. The province spends over $547 million a year just to maintain the long-term care facilities we have now. That's a lot of money. It's a lot of investment; it's a lot of investment in our seniors so that's why I want to reassure seniors that I think we have a good program in place that meets their needs.

Is it challenged? Yes. It's important that people realize that. When I discuss with people how much we invest in long-term care, they don't realize it. This year we increased our support to long-term care, but $537 million of a $3.9 billion budget goes solely to long-term care - the third highest component, just under physician resources and then just under district health authorities. District health authorities consume $1.6 billion, physician resources consume $740 million, and the next one is long-term care.


We invest a lot of taxpayers' money into a system that is there to support seniors when they get to a point where they can't take care of themselves. And, more than just seniors; in long-term care there are more than just seniors who call a long-term care home their home. It's there to support the community. No question, a large majority of that is geared towards seniors so investing that much money into seniors' care is extremely important, it is extremely complex.

As the member said, there is a lot to oversee when you spend over a half a billion dollars on a program and some of the challenges we have is that we've seen the construction of new and replacement beds over the last number of years. Even though whatever people say government will always be, whoever is here after me, whoever is here after them will always have to be in the businesses of replacing or looking at building new long-term care facilities. That is not something I think that will just stop.


I said in my opening comments that we have one of the highest per capita ratios of long-term care beds to the population base that we have but yet we still have a long-term care wait-list that has grown, and that concerns me. So I've asked, I know the minister before me has tried to figure out what is actually going on. We're building new beds, we have a couple of new facilities that are opening up - I think one of them is close to the member for Argyle's riding - Nakile. So we're continuing to look at that and there are requests in now for replacements because a lot of these facilities are aged and we're going to have to look at that and we're going to have to continue to look at that into the future.


Trying to get information to people about where they are on the list is a challenge. When we looked at the long-term care wait-list and we see a growth in it, over 43 per cent of the people on that list waiting to go in a long-term care facility have not accessed home or community care which baffles me because if we can support them in their homes - I think a lot of people would rather stay in their homes than be rooted up from maybe a homestead or a house that they lived in, they raised their family in and enter a long-term care facility. They're very nice, no question, a lot of the new ones are built very well but they are expensive. A new long-term care bed construction cost can range from $250,000 to $350,000 per bed. It's very expensive to get into, they are expensive to build, and they are expensive to run so there are challenges.


Why are 43 per cent of those people on the wait-list not gaining access to home or community care? Last year we put another $22 million in the budget for home care which has an overall budget of $196 million. Here we have, just between long-term care and home care, $730 million, we're pushing a billion dollars just in two services, long-term care and home care but what we see is such a dramatic difference between the home care budgets over the years and the long-term care budgets. Knowing that 43 per cent of the population on that long-term care list don't access home care services we need to engage those individuals and find out - you know a lot of them are legitimately on the list because they're at a point where they've got an ailment that they can't sustain living on their own. Everybody is legitimate I didn't mean to say they're not legitimate but everybody on there is on there for a reason.


Now are there people on there that could get support from home care through some of the many programs I mentioned - and I won't go through all them - in my opening remarks and as the member said earlier about dialysis and programs for Seniors' Pharmacare and Family Pharmacare, one of the areas I think we need to improve on is ensuring people know about the programs we have. We have a number of continuing care or home care services that are available for individuals. Of course you can go out and buy it yourself privately but we have many programs that we supplement and support an individual depending on their wage or their income.


Some of the challenges are trying to figure out where you fit on that list and we have a high percentage of people who were on the long-term care wait-list who, when they're first contacted by a care coordinator who says, okay, we have a bed available first thing - there is some time given to the family or that individual to try to make a decision. You've got to think, you're getting a call one day that, okay, you can move from your house - where you might have lived your whole life - into a facility. That's a hard decision.


I know the member has dealt with it as a paramedic - I have - knowing that you're constantly going back to someone's residence and realizing they shouldn't be on their own, and then the family or them having to make that decision to say, okay, we need to put our loved one into a long-term care facility or on a wait-list. It's probably one of the hardest decisions anybody would have to make, and that's one of the reasons we give a little bit of a timeline, to allow families to make those decisions.


A high percentage of those who are contacted for the first time refuse the first bed offered to them. If you're on a list, I think you can rate a number of facilities that you would wish to go to, and you have a number one option and then you list them in that order. When a bed does come up they are contacted, and there is some time to allow them to make that decision. Some of them refuse, so they go back on the list, and the challenge is they can't be on the list for that facility that they've just refused, so they're put somewhere on the list. It's very hard to give a date on when. Everybody knows how long they've been on the list. Some people choose to go on the list early because they hear there is a long wait-list, and I think that is something we need to work on.


What we need to do is ensure that there are programs available for seniors when they need it so that they don't feel they need to go on the list early. Maybe they're starting onset of Alzheimer's, for example. People with Alzheimer's can live at home for some time if they have support, and we have a number of programs through technology or dispensing medication, automated so they can remember to take their meds, so that they can control their disease, for example. We have programs where people can come in and support them through preparing a meal, or even just helping them with whatever ailment or disease they have.


It is challenging, and there have been changes over the years to try to make that system better. As the member opposite mentioned, at one point you would just contact the nursing home in your area, but there were challenges with that. There were a lot of times when beds weren't utilized, because no one in Windsor called the Elms, for example, and needed long-term care, but if you came to Sackville there might be 100 people who needed a bed, who might have been from Windsor and might have taken that bed.


They went a number of years ago - I don't know how far back, I think it was within the last 10 years, or maybe 12 - that they went to single-entry access to long-term care to ensure that we maximize the use of beds across the province. The challenge is trying to make sure we get the proper placement for an individual as close to their home as possible, and that's not often. That doesn't happen every time. There are many things behind it.


I encourage family members to talk to their clinician, their family doctor, or the care coordinator to try to see what options are out there. One of the things we need to do a better job at is ensuring that people know about the home care services that we have. We want better care for seniors across the province. We want them to live well at home in their communities, where they're from, and that's why we've seen an investment last year of the additional $22 million. That's why we see an additional $2 million to that this year, so that we can promote the programs under home services, and make sure that people are aware of their options.


It's a challenge, and I think you hit it. You've also been critical of the system when you were in government, and there are things we're trying to work through. I'm always open on how we make that better and how we provide better services for individuals in the province, especially around home care and long-term care.


We see across the country that many jurisdictions are challenged with this. That's why I think we need to move forward on both fronts. We need to continue to monitor the number of long-term care beds we have, the replacements, the renovation of those beds, but also home care services. Building beds alone hasn't reduced the long-term care wait-lists. By moving both of those programs forward a little more or even maybe moving home care services up a little bit so that we can address the 43 per cent of people who don't use or haven't gained access to home care or community care - maybe they'll say, oh, well, if I have a little bit of help, I don't need to be on a long-term care wait-list. I'll wait until I need to make that tough decision and then go on there.


I understand the frustration from the member opposite. I encourage Nova Scotians to talk with their families, educate themselves on what services are available. Families need to talk about that, because often when a crisis or an ailment hits it's a difficult time. Maybe you don't know the wishes of the individual, if they're suffering from something that might impair their judgment or not allow them to understand exactly what's going on.


It's an area we need to continue to work in, but we invest heavily - as I said, $537 million a year. The third-largest component of our budget this year is just long-term care. We need to try to find ways to improve access to it, but we also need to improve access to services that will hopefully keep people at home longer and provide appropriate care where most people need or want to be. Long-term care facilities should be an option of last resort for somebody, right? Keep them in their home, support them, give their family support through respite care. Stuff like that is important.


MR. PORTER: Thank you, minister, for that synopsis. You talked about a lot of things in there, and you did everything except answer the question that I was really looking for. I'm not totally surprised, but maybe you'll have - no, I know you'll have opportunities, because I will be back.


We've got a few minutes left here, and I want to talk about that some more. You did hit on a lot of good points there. Yes, we talk to people all the time, and we tell them, you know what - and they know health care is a very huge piece of the provincial budget. They know what it costs. They might not know the $500 million figure, but they know it's extensive, and they care about that. I've always said, and you've backed it up, that if you went into a nursing home or a long-term care facility and you asked how many wanted to be there, there wouldn't be many people saying, I wanted to be here, it was my lifelong dream to end up here at the Windsor Elms. It's not. We know that.


We've had family members - I have; we all have - who have gone through this piece at one point or another and certainly did not want to be there. Anything that we can do to keep them in their homes is absolutely a wonderful thing, and I think that they would agree with that. They need support in doing that. I think you quoted maybe $300,000 or $400,000 per bed to create, maintain, and so on. That's a lot of money, so I'm sure you're looking at that figure and going, what's the cost in comparison to keep them at home?


One of the problems here, though, that I've seen - and again, you're right - I've been critical of past government, too. It didn't matter to me. This is about the people I represent, not the Party that's in power in this province. That means nothing to me, because it means nothing to them, in all honesty. What they look at is, how well I'm going to be looked after and what options I have and what supports there are. They don't really care about the politics of any of it. When it comes right down to their last days of being looked after, they know that they need supports, and that's what they want. That's important.


As I've said, I've seen the single-entry system as a failure because it's too far away. That's one way to analyze it. When I started as a paramedic it was not unusual to go over to the hospital (Interruptions) A long time ago, he says. You're right, it feels like it, too - a long time ago. You would go into the hospital and you would pick up Mrs. Jones or whomever and you would have all the arrangements made because a doctor would have called over to Dykeland Lodge or the Elms and said, hey, Sherry, do you have a bed? - or whoever it might be working there at the time - yes, bring them right over.


That was done, and it was simple. There were never any wait times, per se, that I experienced through that process. Then all of a sudden there was this decision that, oh, maybe we should do it centrally because of this.


You touched on something that was interesting there. You mentioned the turnover and wait times for beds and vacancies. Well, just for your own clarity - and I think I've probably written you on it, or maybe the previous minister - I know of a home that was almost a month with a vacant bed in the current system that we live in now, so one system didn't improve that at all. I've never known that to happen in older days, although it could have prior to my time working in the health care system.


I think that there is somewhere in the middle there. We talk about looking after people at home and wanting to be able to provide the service, and that's a great thing to say. It's great to spend money investing in it, but more importantly, there has got to be the local aspect of having people there to do the job and support the program that you want to put forward, i.e., health care workers out there working in the field who want to do home care. I think that they are there, and I think that people through the CNAs or - what are they called today? LPNs? I would be corrected by my wife very quickly - we're all nurses, I hear the story regularly, just like we're all paramedics, as you and I would have heard over the years, so I appreciate the scope of practice.


It's important that we recognize that, and those people are there. They're going to school. We have a great program in this province whereby LPNs, nurses, and paramedics - we've seen different collaborative measures being used. You've promoted the Collaborative Emergency Centres, and you and I have talked one-on-one outside of this Chamber about different ideas for Hantsport when they were struggling with a doctor, about what might work down there.


Maybe we have a bias, as former paramedics, that we think we have a skill set to offer in communities. There has been a lot of discussion over the years about what medics might do out there within their scope of practice that could expand to the home care side of things. We still don't see a whole lot of that. We've seen a few pilots, and from what we know they've worked well in certain areas of the province.


I realize there is a lot more to getting that up and running than just saying it. There is a lot of work on that. I think that we need to back away from the central single-entry system. We need to bring back a more local flavour to help with this.


I agree with you that building more long-term beds is probably not the answer, although there is something to be said for adding to the number. Now, I was critical as well - we built a brand-new Windsor Elms Village - 108 beds, $36-point-some-odd million. I might add that that came in on budget, which doesn't happen very often, and I credit that to the good team of people who were down there doing that project and working on the board. But I guess what I wanted to say on that was, what an opportunity to expand when you were doing something there - like to add another 20 or 25, or take that to a 150-bed facility. There would have been a prime opportunity at that point, knowing that, as much as we want to leave people in their homes, and they want to stay, we do have a need.


I hope that when we're looking, if we're ever looking at replacements again - and I hear of one down Nakile way there that might actually take place at some point, and I'm sure that the member is going to talk about that after a bit - but I hope that we're analyzing this to the degree that it really needs to analyzed, not just saying, oh, we can't afford that. We can't afford any of it to begin with, anyway. As long as we've got a deficit, we can't afford it, but there is a need to put that investment into communities and to replace some of these homes. I hope that when we're doing that, we look outside a little bit more to say, we probably should have added to the Windsor Elms because it made sense. It really made sense at the time to do just that. That's just one example.


There has to be a more local flavour with how we're placing, and I'll always argue that no matter how long I'm here, probably - and what other scopes of practice, i.e., other clinicians, may be able to assist in the home care piece of keeping people in their home who want to stay there.


I know I'm running a little short on time. I only have a minute or so left here, but there is a lot to talk about in this. Perhaps when we come back together you'll expand a little more or more clearly answer the question that I initially asked. I think that it's an important one when we are saying one thing and not doing the other. I don't mean that to sound negative, but when someone's calling, whether it's me on their behalf or it's a family calling to say, where is Mom or Dad, or whomever it might be - and I also agree with you that it's not just seniors. It's brothers and sisters and of all ages who require long-term care in this province - where are they on the list? I realize there is a whole variety of different priorities too, health care and what situations. All of those things matter, and when you turn a place down, where do you fall back in the list? Do you stay where you should be, just passed to the next one? You should always be somewhere. It shouldn't be that difficult, but I guess there are challenges with it. Believe me when I say I appreciate those challenges. We've got a lot of people on the wait-list in this province. We really do, and I know that.


I think it's fair, though, to those family members who are calling and trying - because it's usually the family members who are looking after with power of attorney or whatever it might be, trying to help get someone placed, but they're not getting the answers. I think that they are entitled to an answer, and I'm not sure why that has stopped. There was a point when - you know, we were always able to help, and when they called, they were able to get an answer. I'm sure that, although there are challenges, the answer cannot be that difficult. Some kind of answer has to be made available to these folks who are waiting, and I think that that is only fair. I encourage you to do what you can to make that happen. That's a big piece of what we do. We need to be able to help do that. Again, never mind the politics of it. We're not interested in that. We're interested in looking after the people, who deserve to be looked after.


I know we're out of time. I look forward to coming back - probably that will be Monday - and carrying on our conversation. Thank you, minister.


MR. WILSON: I'm more than happy to follow up on the next round, because there are some areas where we're trying to move forward on trying to make the process better. There are always challenges when you change from single-entry access to what we had before. I look forward to that.


MR. CHAIRMAN: The time for the PC caucus has expired, and it has been suggested that we take a 10-minute break.


Is that agreeable to all?


It is agreed.


[12:01 p.m. The committee recessed.]


[12:16 p.m. The committee reconvened.]


MADAM CHAIRMAN: Order, please. The Committee of the Whole House on Supply will resume with questions from the Official Opposition.


The honourable member for Kings West.


MR. LEO GLAVINE: I'm going to start this hour with some questions around the communications budget, so we'll spend a little bit of time there as it pertains to the Department of Health and Wellness.


I was looking at the Supplement to the Public Accounts covering fiscal year 2011-12 on Page 156. The Department of Health and Wellness made either a grant or a contribution to Communications Nova Scotia in the amount of $43,652.84 for advertising. I was wondering why the department would be making a grant or a contribution to CNS for advertising. How was the $43,000-plus spent, and on what particular advertising?


MR. WILSON: CNS bills us quarterly for any work that they do. For example, we have some Communication people within the Department of Health and Wellness, but they ultimately work for CNS. They'll be in there, and often throughout the year they'll leave and go to another area within different departments. They bill us on a quarterly timeline.


I'll try to get some more specifics on the $46,000, but it would have been for some work that was done within the year on utilizing CNS. It comes around about properly having accounted for the services. They work for CNS, so under their budget they need to make sure they recoup the money. It's interesting to know - it all comes from taxpayers, but because they fall under their umbrella, they need to account for the work and the cost of the work that they're doing. We get billed from CNS like any other department, and we need to pay that.


I don't have specifically what the breakdown for the $46,000 was. I'll try to get that for you. We do a lot of work around promoting and trying to promote our programs in the province, from Seniors' Pharmacare to long-term care to public health information and safety messaging that we do on a regular basis. I'll try to get more detail from that, but it's because they bill us quarterly for the work that they provide and the support they provide the department.


MR. GLAVINE: This perhaps will have much the same response, but if you follow along to Page 163 of the Public Accounts Supplement for, again, 2011-12, I note that there is another expenditure by the department to CNS. Again, it's advertising - to the amount of almost $285,000.


Could the minister please point to which line item in his budget would have been used to pay Communications Nova Scotia a total of $328,000-plus for advertising? I guess determining this inside the budget is a very difficult task to follow, so if the minister could shed some light as to where that is accounted for in the budget?


MR. WILSON: Thank you. It's under Page 13.4, and it would be under the line item of General Administration. That total cost would have those costs included in that line. So 13.4 - I think it's the very top line item there.


MR. GLAVINE: Could the minister please indicate how much he has budgeted for this fiscal year for advertising, and under which line item this expenditure would be found?


MR. WILSON: We have a number of different initiatives that we need to ensure Nova Scotians know about, like health strategic initiatives, Better Care Sooner, a problem gambling strategy, physician services, pharmaceutical services, and something as simple - well, not "as simple," but something like GP recruitment and retention advertising. Last year, we spent about $531,300 on all those initiatives, and we forecast roughly the same this year.


Some of the examples within those costs - that are under those cost centres - are enjoying the outdoors safely, Thrive!, ads for sporting events, health and clinic and CEC openings, provincial district health authority advertising, so we support that. We did some advertising for the mobile mammography unit that travels the province. We also did a program on television around the flu shot, and also in-school youth health services, and also even talking about some of the things we've done, like reducing generic drug costs. So there are a number of initiatives that we need to ensure that Nova Scotians know about, and we're trying to make sure that we have control over that budget. For a budget that is $3.9 billion - $531,000 is a lot of money, but relative to the important services we provide and the important information that we need to ensure that Nova Scotians have access to, I think that investment is a wise investment.


MR. GLAVINE: The minister does give a very good explanation around the need for some of the advertising. There are new programs and there are changes that go on within a year, and I guess we would say, advertisements are going to benefit the health of Nova Scotians.


But I would say that perhaps there's a bit of a shift to more partisan advertising when we're looking at something like the CECs, because they are in only six or seven of our communities. They're not really a benefit to the entire population of Nova Scotia. Many cannot - in fact, there's only a small percentage who can access CECs, because they are in our smaller communities. So I'm wondering, with that ad continuing, how much more does the department, does the minister, plan to spend on that particular ad in this fiscal year?


MR. WILSON: I think it's extremely important as a government, as a department, to ensure that Nova Scotians know that there are services available for them. The member brought up the Collaborative Emergency Centres and the Better Care Sooner ads that tell Nova Scotians about the change in how we are providing emergency care and how Collaborative Emergency Centres are working.


This is where I'll maybe disagree with the member - I think they do impact everybody. We're not stagnant on how we live our lives. Many of us take vacations in and amongst our communities, and many take travel days, so I think it's important that Nova Scotians know that if - for example, I know that the population of Parrsboro and that region goes up dramatically in the summer because of the number of cottages that are around that beautiful part of the province. I think that all Nova Scotians, even if you live in Yarmouth, should be aware that we're providing services - and better services - in communities like Parrsboro, like Springhill, like Tatamagouche.


Individuals who may have summer places in those communities know what the history has been with closures to the emergency department. They didn't know from one day or the other if it was going to be open or closed. Now we're moving to a model that not only provides better primary care but covers the closures after hours. I think it's important - and I think we'll probably disagree - for all Nova Scotians to know that those changes are happening.


We're not stopping with just the seven. We have a number of initiatives through the CECs that we're going to implement this year. We've talked about Lunenburg, and I most recently talked about New Waterford, which will be the next one to come on-line. They're spreading across the province, and we need to ensure that Nova Scotians know about those changes so that, if they find themselves in that community, they're aware of the services that are being provided at the local emergency department.


MR. GLAVINE: Since I'm dealing more around communications and advertising and so on I'll stick with that, and maybe ask a question later about the CECs.


Back to Page 163 of the Supplement to the Public Accounts, the Department of Health and Wellness paid CNS $47,505 for something called Brand Nova Scotia. Could the minister please tell us what Brand Nova Scotia is and why his department would be spending $47,000 on it?


MR. WILSON: I thank you for the question. I don't have that information at my fingertips, so I will endeavour to get that. They're pretty quick on getting information to us, so I will try to get a breakdown of what that stands for.


MR. GLAVINE: The next figure, Page 163, the Department of Health and Wellness paid CNS $403,354.73 for graphic displays. It's a considerable amount of money. Could the minister list graphic displays purchased for that amount, and give us some indication as to how that almost $500,000 is being spent?


MR. WILSON: I know he'll probably continue down that page, so we're trying to get the details on each of those items. When we do provide new models of care or a new program that we do have within the facilities themselves, a lot of information is provided to the residents who use the Collaborative Emergency Centre, for example. If you go into a Collaborative Emergency Centre, there are new signs on the facility itself - in our Better Care Sooner pamphlet, for example, in any community that utilizes or has changed the model to a Collaborative Emergency Centre. Of course, there is a cost for putting up - like in Parrsboro, it's called the South Cumberland Community Centre Collaborative Emergency Centre. As you walk in they indicate where the primary care clinics are, for example. Many of the CECs - some of the money that we've invested is to make the flow a little better, so as you come into the emergency departments - if it's an emergency, you go to the emergency department. If you're part of the service that we're providing with same-day or next-day service - for example, you might have been in the night before and you have an appointment the next day to see a physician - you may be directed toward the back of the facility, where new offices have been renovated. The clinics are there - the primary care clinics, the emergency department - so when you go through we want to make sure that residents know, so there are new posters and the need for graphic design.


We will get a more detailed breakdown, but I know some of the money has gone toward that to make sure that people in the community know how to transition through this new process or new model of care. We've been quite successful ensuring that people are educated and know about the services and the change in model of care. I think one of the reasons we've been successful in communities where we've placed CECs is because we put a huge emphasis on ensuring people are educated before it even opens. That's why in New Waterford we're currently working on information to get out into the community, so under the next line item, we utilize - I think it's Queen's Printer - and I know we're not allowed props, so it's right here. It's an example of a leaflet that will go into all the households in the community. It talks about the Collaborative Emergency Centre and exactly how you gain access to the primary side of things - for example, the phone numbers. That's why I think we've had success with the buy-in from the residents. We want to ensure that they know about all the options.


Yes, we may have just had a new Collaborative Emergency Centre, but we want to make sure that people know about calling 911, because we don't want - and as a paramedic, I don't want - people who are having angina or having a heart attack to drive themselves to the hospital, and many do. We want to ensure that they know that there is a suite of options in communities that might see a Collaborative Emergency Centre, so calling 911 - on a lot of our pamphlets we'll have the 911. It's like a thermostat on the back of the pamphlet, and right at the top, if it's red - and it gives some examples - then call 911.


Also, we have "Take a trip to the ER," so if it's more - you know, you're concerned that you can't wait until the morning to see a doctor, get into the emergency department or call the CEC itself. If you think, maybe I'll see what they have to say, or now calling 811, which has been greatly received by Nova Scotians - over 400 people a day call 811. It was really tested through the H1N1 crisis that we had, because they were inundated by people who were concerned about that. Then also getting care at home - giving little examples of, if it's something very simple, maybe you can help yourself at home and take ownership.


A lot of what we do is work with CNS for the communications expertise that they give us, so they bill us for that. We utilize the graphic design capability of CNS. We also use their capability of printing material, and that's one thing that we've seen over the last little while, that's really conscious of reducing our printing and paper costs within the department. It's an area where we need to save.


If we're asking district health authorities to save money in health administration costs, then the department needs to show leadership and do that. I think we've done that over the reduction of hundreds of FTEs over the last number of years in our department alone, but also making sure that when we do print stuff, for example, they're not - the member has been in the House as long as me, and I remember the former government, some of the brochures that came out were pretty fancy, very expensive. Ours are pretty simple. We try to keep the costs down on them, realizing that we've asked other partners to reduce their costs in administration. I think we've led by example by trying to do as much as we can in-house. We utilize the Queen's Printer and we utilize communications people with CNS, and I think that's really the way we should be going.


MR. GLAVINE: I said the minister and I get along pretty well. He's now anticipating my questions, which was the one on the Queen's Printer, so we have that info already provided.


Support services through Communications Nova Scotia is a total of $659,000. Could the minister confirm whether these would be salaries for communications officers who would be responsible to the Department of Health and Wellness?


MR. WILSON: Quickly going back on some of the costs of the advertising, I know with the CEC campaign we spent about $22,000; the Better Care Sooner campaign is about $127,000. Those are a couple of the figures out of that, but that line item under there is for salaries.


We have seven Communications people in the Department of Health and Wellness, and I have to say that they're extremely busy. We receive hundreds if not thousands of pieces of correspondence a week. Hopefully the member appreciates the sheer number of requests for interviews - not only from our own media, and maybe that's part of the downfall of bringing forward some great initiatives. I've done media from across the country and around the world on some of the initiatives, because they were firsts - for example, the first jurisdiction in North America to have ski and snowboarding helmets generated requests from across the country and around the world; being innovative with Collaborative Emergency Centres and doing interviews on that.


We have seven dedicated individuals within the Health and Wellness Department who work on different areas, so you can appreciate that we have long-term care, pharmaceuticals, home care services, provincial programs, EHS, capital grants, public health, primary care, physical activity, sport, and addictions and mental health. They all cover off certain areas, because you can imagine how much information, how many programs and services are involved in each one of those. It would be very difficult to do it with one or two individuals.


I think we have the right number of communicators, and I'm sure people who work within communications would love to have a few more so that they don't have to work as hard. They do work extremely hard. It's important to make sure that when we get requests for information from Opposition members, from the media, we have accurate and up-to-date information. Really, that's what they do: they ensure that I'm as well prepared as possible when I answer questions. When you're dealing with a budget of $3.9 billion, there are a lot of figures, facts, and numbers in there, and we want to make sure that we do it right.


We have seven dedicated people who deal with all those different areas within the Department of Health and Wellness, and I thank them for the work they do. That line item covers the wages.


MR. GLAVINE: All in all, the department charges out about $1.9 million for work done on behalf of the Communications Nova Scotia department. Could the minister indicate if the budget is similar for this year? What line item do we see this advertising dollar incorporated into?


MR. WILSON: It's under General Administration. Last year's budget, 2011-12, was $1,025,200. Our budget for the upcoming year is $1,027,400, so an increase of about $2,000, which I think reflects the work that we're doing to try to ensure that we don't have those escalating costs year after year after year. Part of that is some of the wage increases, but we've worked extremely hard to keep those numbers down, and I think it's reflected in a small increase in the upcoming year.


MR. GLAVINE: Just a couple of specific questions around this budget area. Your assistant did tell me that she does like this line of questioning. It keeps her busy and engaged. So I needed to acknowledge that.


Just a couple more questions related to the recent supplement, then. On Page 166, the Department of Health and Wellness paid $827,172 to the Barrington Consulting Group. I'm wondering what this expenditure was for.


MR. WILSON: As the member hopefully could appreciate, as we work on and move forward on a number of initiatives, we need to make sure we get some of that expertise externally. I think governments in the past have always done that, because it is cheaper than having individuals within the department providing all that expertise, so we utilized them on a number of different occasions.


The alternative funding model, for example, around physician services - very complex, a lot of money involved in that, it costs over $740 million. It's the second-highest portion of our budget. So we, at times, utilize them for their expertise, to try to make sure that when we enter into a contract, for example, or change the way we're doing things, it's in our best interests and it's in the best interests of taxpayers. We go out and seek that expertise, and we utilize them through Better Care Sooner as we look at the 35 areas of improvement that we're trying to work on.


There are a number of areas where we utilize their services, and there is a cost to that. We know that. But I think the cost of it is much more manageable in the way we do it; we don't retain them for the full year. We utilize them on specific projects, so we're able to keep our costs down internally. We bring those experts and consultants in when we need them.


MR. GLAVINE: I had another one around a consulting group, but I'm sure it's much the same kind of requirement by the department.


Turning to an area of health care that we know is critical to strong and effective front-line health delivery, and that is with our nurses. Any of us who have spent time in hospital know only too well the role they play, and their education level, their level of expertise, especially those who have moved on to a specialty within health care. So on Page 13.11 of the Estimates and Supplementary Detail, slightly over $9 million is budgeted for the Nursing Strategy. I'm wondering what is planned with this $9 million, and specifically, what the $9 million will be spent on?


MR. WILSON: Part of that investment is to ensure that we have the capacity in Nova Scotia to continue to bring forward new nurses. For example, we pay universities to have a certain number of nursing seats - so CBU, Dalhousie, and a number of other ones where we support the universities to make sure that they have what we're hoping for. I think we've been pretty successful over the last number of years with the number of new nurses coming on. We always need to continue to ensure and advocate, especially with our young people, that nursing is a profession that's well respected and is so important to provide services and care for people.


A lot of that goes toward those initiatives to make sure that we have the right number of seats in the province, so that we can continue to see new graduates coming out of the nursing program who can hopefully stay here in the province. I know in my 10 years in this Legislature - in the early years, early 2000s, there was a strong exodus of nurses leaving the province. I'm not saying that nurses don't leave the province now, but I think we have a good environment where nursing students are feeling comfortable with the opportunities to work as a nurse that they're presented with here in Nova Scotia.


There are now opportunities in a number of different settings - not just hospital settings. I think that is appealing to people, and that's why we need to continue to expand our collaborative clinics around the province. I know Shelburne will be having a new collaborative clinic in that area of the province, in hopes that we can recruit, retain, and ensure that physicians and nurse practitioners will go to that part of the province and work in a collaborative team approach.


I think all new graduates, no matter what discipline in health care they are graduating from, want to work in an environment that's supportive and is supported by other professions. The days of being a doctor and you taking care of everybody's needs in the community are gone. We need to maximize the use of the physicians and the time they can provide care. We need to maximize the use of nurses and nurse practitioners. We have them in collaborative clinics, we're utilizing them in nursing homes, in hospital settings - registered nurses, LPNs in long-term care facilities.


We need to ensure that we have the right mix of health care providers, and I think over the last number of years we've been what I will call "stable" in attracting and retaining new graduates, especially nurses. That's where some of that money goes, to make sure we have those seats available for that new crop of nursing students who come through. I encourage the member opposite and all members to encourage their young people to look at nursing as a potential option for a career. They're so much a key to the success of the health care system, and over my career I've enjoyed working with them in a number of different settings.


MR. GLAVINE: There is actually quite a dramatic change in that budget area. An actual $9,051,000 represents a decrease of just over $5.1 million. That's a substantial decrease at the training level, at the professional development level, or at the whole provision of adequately implementing the nursing strategy. Can the minister account for such a significant decrease?


MR. WILSON: We can. I'll go through a quick list of what we've done. What we did is transfer some of those grants to Labour and Advanced Education. We've transferred, for example, a nurse practitioner grant of $150,000; we've transferred St. F.X. nursing seat funding of $2.4 million; we've transferred Cape Breton University nursing seat funding of $1.7 million; we've moved Dalhousie nursing seat funding of $747,000; and we have a nursing school wage adjustment in there. So that's a total move of $5.086 million. There is a small portion that we can get into if you want, but the main reason is for the move, transitioning those funds to Labour and Advanced Education, which I think reflects more on the support that that department will give to universities and stuff - just being clearer on how we allocate and where we put certain programs in budgets. So that's where that move went.


MR. GLAVINE: Phase two of Nova Scotia's Nursing Strategy was developed in 2007 and was a three-year plan, taking it to 2010. Could the minister please tell us whether there will be a phase three developed, and if not, why not?


MR. WILSON: Hopefully the minister can appreciate that I wasn't in this role in 2007, but one of the things we continue to do is to monitor and recognize that the workforce has changed. As I mentioned in my previous answer, we're not seeing the numbers of nurses leaving the province that we did in earlier years. We continue to look at it. If we need to come out with something new we will do that, but I think continuing to monitor the workforce - recognizing that we're in a stable period right now, but always being mindful that things can change, and that there are different reasons why the workforce may be impacted in one way or another.


Maybe I shouldn't even talk about this - maybe you'll talk about it later - but for example, paramedics. I know the member opposite was in the media around paramedics. Recently we had a company from Alberta come into Nova Scotia and actively recruit paramedics. Some of them are going, and I recognize that. That has made us look at the workforce and see what is going on, and we do the same thing with nursing, so right now I think we're in a stable position. We talk on a national pan-Canadian level on health human resources often. At every meeting I've gone to in the last year, we've talked about this, because we know that one of the things that we can't continue to do is compete against each other.


We need to ensure that we have the right mix of health care providers here in the province. That's why I was glad that our government did the physician resource plan - the first in the province - so that we know what the foundation is, who we have working in the system now, and what we're going to need in the next number of years. That allows us to adjust programming, maybe, or grants, potentially, so that's what we'll continue to do with nursing. We'll continue to monitor the workforce and how it's changing. We know that all jurisdictions are going to have to deal with the simple lower number of graduates in high schools every year, for example. This year alone - compared to last year, this September had 2,000 fewer Grade Primary kids. That means in 13 years - hopefully nobody fails - we'll have 2,000 fewer people graduating, potentially 2,000 fewer nurses in the province.

We need to be mindful of that, so if we need to move on that we will, but currently we feel comfortable that we have a good grasp of the work environment and revolving nurses. As I said, if we need to go and we need to look at a new nursing strategy, we will. We're always mindful of ensuring that we have professional development opportunities for nurses, and always mindful of ensuring that we continue to recruit new nursing students, because we know the population demographic age shifts with retirements. We have to continue to move on that, and I think we're doing it quite well right now. If we need to change the way we're doing things, we will. We have the capability of doing that, and we've seen it through strategies in the past. If we need to implement one, we will.


MR. GLAVINE: Not directly related to the Nursing Strategy are continuing care assistants. I know there's a bursary program that has been offered by the Department of Health and Wellness for continuing care assistants. Can the minister confirm that this bursary is no longer available as of the end of March?


MR. WILSON: That's another area where you have to continue to monitor the workforce. With the construction of new long-term care facilities, we needed to ensure that people were going in that direction, that we had students going to the community colleges to become LPNs and get into that profession. We've seen over the last number of years that providing small bursaries - they were very small - wasn't driving students to go and get trained. They were coming. It was very successful, and we feel very confident that as we move forward we will see those students are still utilizing those opportunities to get trained, changing their professions.


If we need to shift it, we will. We're confident that the numbers of students who are gaining access to those programs are doing it because they want to get into that field, and having a small, small bursary hadn't had a huge impact in making those decisions. As we work through a budget we're trying to find and ensure that we're supporting services like recruitment and retention of health care providers. We're confident that those numbers are coming, so we're looking at other opportunities to make sure we're supporting those individuals through the Department of Labour and Advanced Education, because they're looking at different support services, I'm not the minister of that, but that's why we've moved some of the nursing grants over to Labour and Advanced Education.


I think that department is in the best position to gather what's going on in the workforce, even though we're very mindful of it. We're keeping our attention on it, but we're allowing for another department to move in the direction of providing services for students and for Nova Scotians who decide they might have a career change. This is meant to be a temporary thing when we open new beds.


We knew we had to do something to kick-start new opportunities for Nova Scotians when it came to working in long-term care, so knowing that a bunch of new beds, over 1,000 new beds were coming on - that bursary was put in place to kick-start and get the attention needed for those programs. I think we've been very successful. The community college has been very successful in getting the attention of Nova Scotians to go to their facilities to go to school and upgrade. We feel confident that we're moving in the right direction when it comes to the LPNs or the CCAs who are coming out of the community colleges.


MR. GLAVINE: I know that was a lengthy "no" for the answer I was seeking, but with that being said, I thank the minister for his explanation.


Just as a bit of sidebar now, could the minister let us know how much was actually spent on this program during the last fiscal year? I know that, as you said, on an individual basis there wasn't a significant amount of money going out to each applicant who came into those programs. However, that amount of money, as the minister has suggested - it did include a fair number of people who are actually doing a job change, a shift in career - perhaps more significant than what the minister has addressed here. I'm wondering about what was spent on the bursary and how many CCAs were trained and, again, what is the line item that covers this off in the budget?


MR. WILSON: The bursary program had a value of $2.4 million. We had approximately 480 individuals who could get up to about $4,000 with that program, but one of the things that we knew was happening was that those students - a lot of students weren't even applying for that. They were going in trying to get that upgrade. One of the things we did - and I can't talk at length on it, because it's in another department, but one of the areas where we knew we needed to support Nova Scotians - especially our young people, but it's for all ages, again - is through our Student Assistance Program. We've worked hard over the last four years to put more funds into that, and I think today we do have one of the best student assistance programs in the country.


There are a lot of opportunities through services in other departments that allow for Nova Scotians to potentially change their employment, but for young people, opportunity to seek higher education, which is so important. We need to continue to educate our young people - and our old people, too - and ensure that they have opportunities in the province. As you've seen with some of our programs now, they were housed under the Department of Health and Wellness, like the grants and seats for nursing students, and we've moved that out into more appropriate departments - Labour and Advanced Education being one of them, where they do have a number of programs to help young people, new graduates from high school, Nova Scotians who might find themselves out of a job or wanting a change of careers. There are a lot of opportunities now in Nova Scotia to gain access to support and services.


Yes, there would be a reduction in this program under our department, but with the increases that we've seen in Labour and Advanced Education, and with the support that we are seeing in the Student Assistance Program now increasing over the last number of years, we're confident that we're still balancing the opportunities for Nova Scotians to educate themselves more. I think we've done a good job at doing that, all in an environment that has been challenging financially for the departments, but more importantly, for the government. I'm comfortable that the shift by moving a lot of these programs to Labour and Advanced Education will meet the needs, but as I said earlier, in my last answer, monitoring the workforce and the changes in that is so important, especially in health care. We need the health care providers. We need to maximize using a number of them in a team approach.


If we need to have discussions with the Minister of Labour and Advanced Education about health initiatives that we might need to have expanded, then we will do that. I'm confident we're in a good position now, and that those opportunities are there for Nova Scotians - for young Nova Scotians, for those who want a career change, who want to educate themselves more. There are a lot of opportunities there now for some support, not only in community colleges but in other programs that are offered in schools and universities around the province.


MR. GLAVINE: Mr. Chairman, I thought that was the direction the program was going in. However, there is still information on the Web site around the bursary and the availability of the bursary. Again, we had a few calls in that regard, so I just wanted to bring that to the attention of the minister.


I know I just have a short time - a bit less than 10 minutes to go right now. I have a bit of a more urgent situation in my riding that I have addressed with the minister, and it's more on the Wellness side of his department. Yesterday I was passed a draft copy of a letter that will go out to all of the users of the Western Kings Arena that they won't be able to open as scheduled on the Labour Day weekend if they can't have construction of a new ice surface - the cement, the piping, and the boards - underway by early May. I noticed this week that the Hector Arena got $200,000 committed from the province, and I believe very strongly in the equitable distribution of funds to support our children and their programs.


As the member for Kings North, who is now in the Chair, is well aware, we have a very integrated system in the Valley. This is not just because it's in the Kingston area. Western Valley runs from Digby to Waterville, and in fact, the Acadia hockey program, the Acadia Minor Hockey Association, which covers Canning, Kentville, and the Wolfville corridor, has huge demands on their ice time. They come out not just to participate in hockey tournaments and games, but they actually rent ice at the Kingston Arena because that's the more populated area of Kings County - that corridor of Canning, Kentville, and Wolfville.


I'm hoping the minister will be able to give some direction here - I know we're probably going to have a budget passed very quickly - to make sure that those youth programs are underway as per usual. I'm hoping the minister can assist this community.


MR. WILSON: Mr. Chairman, I'm not too sure about the $200,000 for the Hector Arena. The program that the member brought up to me on a number of occasions that we have - they have not passed or been approved in any manner. We can check. I don't know where the $200,000 came from, but I don't believe it came from the province. Anyway, we'll look into that.

We have a program available in the province that supports recreational facilities, construction of trail systems, really trying to improve recreational opportunities for Nova Scotians. We used to have another program that was called the B-FIT program. It had a lot of money in it and was supposed to be around for about 10 years. Unfortunately, the previous government decided to utilize that program in a manner that I think exhausted the funds within a couple of years, which is unfortunate.


When we came into government, that program had to be wound up because there was no more money in it, which is unfortunate. That eliminates our opportunity to support some of these bigger projects. The program I just mentioned for development and support for recreation and sport organizations has a maximum ceiling of $150,000, but I think the total program is only a couple of million. It might be $3.1 million.


We're challenged because, in the member's area, for example - I think we have about $300,000 that's allocated throughout the province, depending on population and the demand, and I think this year alone there's over $1 million in asks. We're challenged. We have people within the districts across the province who recommend certain projects for certain areas, and they haven't been on my desk yet. I know there are a lot of organizations waiting to hear the results of those, but we do have a process that's been in place for the 10 years that I've been here.


These are determined by the passing of the budget, for one. There's a process where the applications needed to be in by the first or second week of February, I believe. Then the evaluations happen, and then the recommendations come to myself after we know the budget is passed. As the member indicated, the budget will pass this year because we have a majority government. We know that, but we still have a process, and we can't jump before that. I cannot commit funding to anybody before the process is complete.


It's my understanding that the member had been at public meetings where he said the province would be in for a certain portion of the project. It's a little early to say that, knowing that the process is that the department evaluates those programs and applications. When I get those recommendations I will do my best to ensure that we're as fair as possible around the province to ensure that as many people as possible can benefit from the limited funds we do have.


I look forward to getting the final recommendations from the area supervisors who are working in the sport and activity areas, but we do have to follow the process that has been in place since well before I took over this role. I look forward to supporting organizations around the province. I know the arena the member opposite is talking about has had some needs over the last little while; they had some of the piping break underneath the ice surface at the start of the year. We were there to support them in that.


Jurisdictions across the province, especially municipalities, work with us intimately to support projects together. They know the process, so for one municipality to ask or expect the province to break how the process is - it can't happen. I think they're fully aware of our willingness to work with municipalities so that we can support projects together and bring down the cost that each level of government might be able to participate in.


I hope the member understands that. I hope the arena understands that we do have a process. We will try our best to facilitate approving the projects as soon as the budget is passed and the Minister of Finance gives me the thumbs up to spend the money. You can't spend the money until it's approved by the Legislature. You can't spend the money until we have a vetting of the estimates, as we're doing right now. I understand the urgency of it, but unfortunately, that's the process. It has been the process since I was on that side of the House in Opposition, and it continues to be the process. I think it's a fair process.


We're going to try our hardest, but I wish I had more money in the program to support these larger projects. That is going to be challenging over the next couple of years, trying to support facilities that have major breakdowns, for example. We know there are a lot of old arenas in the province, but there are a lot of recreational facilities that need support not only from the local municipal government but from the provincial government and the federal government. I'm going to work hard to try to expedite things as the process comes to an end, once we approve the budget - to get those applications reviewed, to get the recommendations from the individuals working in the area and in the Valley, and to try to do it as quickly as we can.


MR. CHAIRMAN: Order, please. This hour in the Liberal rotation has elapsed.


The honourable member for Argyle.


HON. CHRISTOPHER D'ENTREMONT: Mr. Chairman, it's my pleasure to stand for a few moments to speak to the estimates of the Department of Health and Wellness. I want to thank the minister for being here and, of course, his staff. Frances, happy birthday. Linda, it's always good to see you keeping the minister up to date on the files, the numbers, and the information as you always do, keeping subsequent ministers straight in this House of Assembly.


I'd like to start off by saying that I don't think I've ever seen the Department of Health and Wellness come so late in the process. I just wanted to say I find it interesting that when the Liberal Party did put the list together they put it so far down in the end that we might run out of time and not be able to put the time in that we need to look at the estimates for this department, which makes up such a large piece of the budget of the Province of Nova Scotia.


It was kind of funny, I was just talking to the Minister of Finance earlier and she hasn't seen it. She's been here a little bit longer than I have, but Health and Wellness tends to always be the first one up. I remember the previous minister doing 26 hours. I remember doing well over 20, and for subsequent ministers too. (Interruptions) Yes, the minister did keep me there somewhere close to 20 hours in this House of Assembly.

I'm pretty happy that we're here now to discuss these issues. I'm going to start off right where my colleague, the member for Hants West, left off, and that is talking about long-term care and a number of the issues around it. Where my colleague was going at that time was sort of trying to talk about the issue of single-entry access and who's responsible for assessments and how those assessments are done.


To start things off, my question to the minister is, can he give us a quick little overview? If you have a loved one who needs care - and I'm not going to say they need long-term care, I'm going to say they need care - so they need to access a service of the Province of Nova Scotia, they call the 1-800 number. What happens next?


MR. WILSON: Mr. Chairman, I thank the member for the question, as it's the first chance he has to ask me questions around the Health and Wellness budget. I think I did have you up on your feet for about 10 hours for our caucus, and I know the Liberals had you for 10 hours. I don't think we have that much time left.


It is interesting, as you mentioned, that here we are fourth up in the estimates. I've been here for 10 years, and we've always been first, other than last year, when Health and Wellness was up second. Anyway, Mr. Chairman, I take that as a compliment, through you to the member opposite, that the Department of Health and Wellness has worked extremely hard in difficult times to provide services and make positive changes. I hope maybe that's why - maybe we're a little lower on the totem pole in these estimates, or maybe they're just afraid of me, I don't know - jokingly.


I appreciate that health care is important to everyone. There are current hot issues - it's like that at any time in the Legislature - but health care is extremely important. I think that the most important thing people want is to ensure that we have good services for them. When you're talking to people, they want to make sure that they can gain access to health care services. As the member has noted, long-term care is an area where Nova Scotians want to be reassured that there are services there for them, and I want to reassure them that there are services there for them.


Yes, we have a wait time, and there is some attention to that wait time, but last year alone I think we placed over 2,400 Nova Scotians into long-term care facilities. That's a significant number, and that changes every year. It changes daily - the unfortunate side of things, largely due to people who have passed on, who have lived a life in their home and their community and are at the end stage of their life, who require in those final days the support of a long-term care facility. We know how important it is.


As I said in an earlier answer to a question, long-term care in the Province of Nova Scotia is the third-largest portion of our budget. Over $537 million is spent every year just on long-term care, behind physician services and the funds that we provide district health authorities to operate in the province.


With that come a lot of individuals who are trying to make sure that people can gain access to long-term care, that they have opportunities to get the support they need. A number of years ago there were changes on how you access that. I mentioned that at times. We try to reduce the number of days a bed is empty in long-term care facilities in communities across the province, but we do have opportunities, and we recognize the challenge of getting a call one day saying, we have a bed available, when can your loved one move in? That can be challenging because of whatever the makeup of that family or that individual is. Maybe they have to figure out, I have to sell my house, or I have to get out of a lease, or I have to downsize from a house to a room in a long-term care facility. There are a lot of things that people have to deal with, so there is a bit of timeline where we do allow people to make a decision. That can at times allow for beds to be left empty for some time. We're trying to make sure that we have a system that allows people to make the decision but also utilizes the bed to the full extent.


The member's question was, how does an individual gain access to or inquire about possibly utilizing a long-term care facility? We have care coordinators across the province in all of the district health authorities, so there are number of avenues of how you can go and ask for an assessment.


There are provincial criteria for Nova Scotians who want to potentially look at going into a long-term care facility. They do an assessment on them, so we have care coordinators in all the district health authorities. You can call the care coordinator number directly. I believe you can find that number on the government Web site. You can talk to your family physician or primary care clinician, who can guide you through making contact to get an assessment done through the care coordinator. Some individuals gain access through the assessment when they find themselves in the emergency department, for example, where at a certain point they have an ailment or illness or something traumatic happens to them that has changed their ability to take care of themselves or changes the ability of a loved one to take care of them. They can gain access through the emergency departments or even on a floor of a hospital, if it's post-surgery, for example, to a care coordinator who will do that assessment and then determine if they are an individual who would benefit from a long-term care facility.


Some of the work we need to do when that question is asked, or they gain access to a care coordinator to do the assessment, is trying to figure out the options that someone may have. Long-term care is one option, of course, but the home care services or community care services that are out there might be another option. What we've been doing over the last little while is, I've asked to ensure that our care coordinators know about all the different programs that we have in health care that may support someone going back home.


We know that people don't want to be in the hospital, so we just expanded last year a Rapid Assessment program, a home-first program that was utilized in Capital Health. That is an intensive home care program for a number of days post-surgery, for example. If we can get that person out of the hospital and into their home and have intensive home care for 24 or 48 hours, that frees up a hospital bed, but it gets someone back in their home, and then they can set up home care if they need it. There are a number of avenues that people can gain access to. They need to get an assessment done. We have provincial criteria, and there are a number of ways for an individual to get access through the health care system.


MR. D'ENTREMONT: The reason I'm asking this is, as we've been identifying the number of seniors who are waiting for long-term care placement in the province, and as we've identified somewhere close to 2,412 people waiting for long-term care placement, some of the answers that we've been getting have been a little lax. What we are getting is, well, there are a lot of people on there who are on there early because they see it coming, or they're wanting to be on a certain list versus another list.


The truth here is that there is basically a single point of access for all the services for long-term care, home care included. Whether you need a little bit of help around the house, whether you need some further interventions in order to stay at home, or whether finally, at the extreme, you need to be placed in a long-term care facility, it all goes to the same person.


My question that revolves around this one is, as you're identifying the people or doing the assessments for them, are the patients and families, or seniors and families, asking for the other services that are available through the department? Or are they simply standing there and saying, we're at a point in our lives where the only thing we think is available to us is that long-term care bed?


The reason I ask it this way is because of personal experience over the last number of months, where my wife's family - her grandfather and grandmother - ended up coming to a point where they could no longer live at home and needed placement. I watched to the side and had basically warned them years ago - had you gotten yourself into the system and asked for some of the support services throughout the process, some of this might have been a little easier and they wouldn't have hit the wall that they hit.


Again, the question revolves around, as you access the system, are people asking for further services? Are they being identified for other services? To me, 2,400 seniors on a wait-list are far too many. I can't imagine that all of them need level two, but they've gone through your assessment process through your care coordinators.


MR. WILSON: I'll go right to what you said right at the end, I think. I think we all have family members who we try to support and encourage, to make sure that they access services if they're there. The member for East Hants mentioning Seniors' Pharmacare and interactions with the residents and constituents of his, encouraging that the Seniors' Pharmacare Program is a good program to gain access to - you may be healthy and not on any medication now, but who knows what will happen in two or three years? It takes one illness or ailment that requires you to have medication filled, and that's going to be a burden on you. I think we all try to work to ensure that seniors have the support they need. I know that in my interactions, seniors are very respectful. Seniors are reluctant to ask for help. They're reluctant to admit or want to use a service because they think, well, no, I don't want to burden anybody, or I don't want to be a burden to anybody.


That's not what these programs are there for. I mean, we have seniors who have grown our economy in this province. The reason we're able to spend $3.9 billion in health care is because we have an economy and a province that has grown to where we're at now. It's so important for seniors, and that's why when we looked at the long-term care wait-lists and realized 43 per cent of them haven't accessed home care or community care before - we need to look at that list.


That's part of the work we're doing now. That's why we invested another $22 million last year, and another $2 million this year - so $24 million over the last two years - to improve home care services. Part of that is to ensure that seniors who are on the wait-list, for example, know about the services, and making sure that the care coordinators throughout the districts know exactly what services there are. I'm the minister, and I don't think I could still name all the programs. I know about all of them, but there are a significant number of different programs that can support somebody, and we need to make sure that seniors are aware of them.


That's why seniors can ask for reassessment - because of a health status change from their initial assessment, maybe. That's why we're working now to try to put more flexibility into some of the programs. Often programs have strict parameters, and if you fall outside them, you don't get support. In health care, you need to be flexible. We can't offer all these programs for free for everybody. A lot of them are geared toward income levels, and those seniors who might have a lower income level.


I wish we could just say it's free for everybody, but by having the programs we have now, we're still pushing almost a billion dollars in long-term care and home care, so I couldn't imagine if we paid for everybody. But I think people understand that. They want to pay their way, and there are co-pays that people pay for Seniors' Pharmacare, for long-term care, for home care, and for daily rates that they pay. So we utilize a national-international assessment system or criteria, but I know we can try to make improvements to the assessment process, and make improvements so that we can be a bit more flexible - maybe a senior didn't qualify, but they're just kind of around the parameters. The last number of programs that I've signed off on, I've ensured that there is some flexibility.


I look at the program that waives ambulance fees, for example. It's not just, okay, you make under $11,000, you get it for free and you can waive that bill and that's it. We have parameters that will allow for higher-income people. In that program, for example, we ensured that if it's a family of four or a family of five or a family of six, we kept increasing the thresholds to waive the ambulance bill, because we know - you have five or six kids. I have two kids and it's expensive. I couldn't imagine having four or five, like some of our parents or grandparents had, or four, like my parents had. It's expensive with just two, and I know the member opposite has two.

We needed to be flexible with that program, so that's why, when we initially saw the evaluation - and that, I have to say, it was a little more strict - I said, no, we needed to open it up. We needed to be able to have what you'd maybe call a grey area, where someone's just over. That's one of the things we see all the time: a program has a cut-off threshold, and there's always someone who makes $1 more, or someone who makes $10 more, and they can't gain access to the program. So we're trying to look at the programs we have. We're trying to be as flexible as possible, and that's why I made the changes to the program that waives ambulance fees, or allows you to get maybe a portion of that paid because you need to be flexible. There are always circumstances that you might not think of when you are putting a program together. I encourage seniors to educate themselves, or more importantly, their family, on what you would do if a loved one gets to the point where they need support at home or potentially long-term care. Because the more you are prepared, the more you are educated on what is available and hopefully you can ask a little earlier to gain access to some of these programs.


So we are currently working at trying to be a little more flexible on the assessments and . . .


MR. CHAIRMAN: Order, the time available for consideration of Supply today has elapsed.


The honourable Government House Leader.


HON. FRANK CORBETT: Mr. Chairman, I move that the committee now rise and report progress.


MR. CHAIRMAN: The motion is carried.


[The committee adjourned at 1:37 p.m.]